Healthcare Provider Details

I. General information

NPI: 1891725180
Provider Name (Legal Business Name): JAMES M HEPBURN PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 GLASSWORKS RD
GREENSBORO PA
15338-9507
US

IV. Provider business mailing address

7 GLASSWORKS RD
GREENSBORO PA
15338-9507
US

V. Phone/Fax

Practice location:
  • Phone: 724-943-3308
  • Fax: 724-943-4929
Mailing address:
  • Phone: 724-943-3308
  • Fax: 724-943-4929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberS006264L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: