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General NPI Number Information
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NPI Number | 1548479629
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Entity Type | Individual
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Provider Name | DOUGLAS LEONARD GERARDI PHD
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Gender | Male
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Dates
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Enumeration Date | 05/22/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 111 S INDEPENDENCE MALL E BOURSE BUILDING , SUITE # 968
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City | PHILADELPHIA
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State | PA
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Zip | 19106-2515
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Country | US
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Telephone | 215-888-0317
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Fax |
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Provider Business Mailing Address
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Address Line | 111 SOUTH INDEPENDENCE MALL EAST BOURSE BUILDING , SUITE # 968
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City | PHILADELPHIA
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State | PA
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Zip | 19106-2515
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Country | US
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Telephone | 215-888-0317
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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 | PS003108
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License Number State | PA
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