Healthcare Provider Details

I. General information

NPI: 1316276595
Provider Name (Legal Business Name): BENJAMIN E YERYS PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2009
Last Update Date: 07/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3440 MARKET ST SUITE 200
PHILADELPHIA PA
19104-3325
US

IV. Provider business mailing address

3440 MARKET ST SUITE 200
PHILADELPHIA PA
19104-3325
US

V. Phone/Fax

Practice location:
  • Phone: 215-590-7555
  • Fax: 215-590-7387
Mailing address:
  • Phone: 215-590-7555
  • Fax: 215-590-7387

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPSY10000589
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPS017500
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: