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General NPI Number Information
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NPI Number | 1083836712
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Entity Type | Individual
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Provider Name | THOMAS J. GERBNER PH.D.
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Gender | Male
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 15 PRESIDENTIAL BLVD SUITE 202
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City | BALA CYNWYD
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State | PA
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Zip | 19004-1006
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Country | US
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Telephone | 610-667-7667
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Fax | 610-667-7364
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Provider Business Mailing Address
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Address Line | 120 ELLIS RD
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City | HAVERTOWN
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State | PA
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Zip | 19083-1109
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Country | US
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Telephone | 610-449-7757
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Fax | 610-449-1848
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PS-005783-L
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License Number State | PA
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