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General NPI Number Information
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NPI Number | 1235678764
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Entity Type | Individual
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Provider Name | RON NIEBERDING
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Gender | Male
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Dates
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Enumeration Date | 02/16/2017
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Last Update Date | 02/16/2017
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Provider Practice Location Address
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Address Line | 2595 INTERSTATE DR STE 103
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City | HARRISBURG
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State | PA
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Zip | 17110-9378
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Country | US
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Telephone | 800-370-3651
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Fax | 877-515-7147
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Provider Business Mailing Address
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Address Line | 55 HATCHETTS HILL RD
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City | OLD LYME
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State | CT
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Zip | 06371-1534
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Country | US
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Telephone | 800-370-3651
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Fax | 877-515-7147
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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 | 3431
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License Number State | TN
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