Healthcare Provider Details

I. General information

NPI: 1437273869
Provider Name (Legal Business Name): WASHINGTON PSYCHOLOGICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 10/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 HERITAGE VALLEY DR STE 1
SEWELL NJ
08080-1752
US

IV. Provider business mailing address

PO BOX 8161
TURNERSVILLE NJ
08012-8161
US

V. Phone/Fax

Practice location:
  • Phone: 856-589-4147
  • Fax: 856-589-3805
Mailing address:
  • Phone: 856-589-4147
  • Fax: 856-589-3805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1624
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMA027785
License Number StateNJ

VIII. Authorized Official

Name: DR. SAMUEL A BOBROW
Title or Position: OWNER
Credential: PH.D.
Phone: 856-589-4147