MEDICARE: DR. JEFFREY LAWRENCE EIBERSON PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PA LIC. #PS002959L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	246945000	OTHER	PA	MAGELLAN HEALTH CARE
2	4365980	OTHER	PA	AETNA HEALTH CARE
3	438240	OTHER	PA	HIGHMARK BLUE SHEILD
4	0063120000	OTHER	PA	BC PERSONAL CHOICE

General Provider Information

NPI Number	:	1629058870
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY LAWRENCE EIBERSON PH.D.

Provider Business Mailing Address
First Line	:	1326 SPRUCE ST
Second Line	:	SUITE #1905
City	:	PHILADELPHIA
State	:	PA
Zip	:	19107-5826
Country	:	US
Telephone Number	:	215-546-1767
Fax Number	:

Provider Business Practice Location Address
First Line	:	1326 SPRUCE ST
Second Line	:	SUITE #1905
City	:	PHILADELPHIA
State	:	PA
Zip	:	19107-5826
Country	:	US
Telephone Number	:	215-546-1767
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/21/2006
Last Update Date	:	07/08/2007

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