Healthcare Provider Details

I. General information

NPI: 1194870535
Provider Name (Legal Business Name): MARILYN BERGMAN & JUDITH SHECHTER, PTR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 12/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 E LANCASTER AVE SUITE 200
WYNNEWOOD PA
19096-2145
US

IV. Provider business mailing address

308 E LANCASTER AVE SUITE 200
WYNNEWOOD PA
19096-2145
US

V. Phone/Fax

Practice location:
  • Phone: 610-642-2353
  • Fax: 610-642-3278
Mailing address:
  • Phone: 610-642-2353
  • Fax: 610-642-3278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State

VIII. Authorized Official

Name: JUDITH SHECHTER
Title or Position: PARTNER
Credential: PH.D
Phone: 610-642-2353