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General NPI Number Information
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NPI Number | 1124074174
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Entity Type | Individual
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Provider Name | SAMUEL ABRAM BOBROW PH.D.
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Gender | Male
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Dates
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Enumeration Date | 05/25/2006
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Last Update Date | 09/23/2021
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Provider Practice Location Address
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Address Line | 1901 JOHN F KENNEDY BLVD APT 2706
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City | PHILADELPHIA
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State | PA
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Zip | 19103-1523
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Country | US
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Telephone | 856-981-3607
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Fax | 856-589-3805
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Provider Business Mailing Address
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Address Line | 1901 JF KENNEDY BLVD APT 2706
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City | PHILA
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State | PA
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Zip | 19103-1523
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Country | US
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Telephone | 856-981-3607
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Fax |
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSO16076
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 1624
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License Number State | NJ
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