=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619992658
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOHN P BILLIG PH.D., ABPP
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/12/2006
-----------------------------------------------------
Last Update Date | 03/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 26049 KIELBASA CT
-----------------------------------------------------
City | LEWES
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19958-7028
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 612-590-5847
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 26049 KIELBASA CT
-----------------------------------------------------
City | LEWES
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19958-7028
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 612-590-5847
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | B1-0011405
-----------------------------------------------------
License Number State | DE
-----------------------------------------------------