Physician Compare National (NPI:1174674279)

HEALTHCARE PROVIDER: JONATHAN DAVID BIRNBERG PH.D.

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1174674279
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	4183611858
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20080509000531
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	BIRNBERG
	Individual professional last name
Provider First Name	JONATHAN
	Individual professional first name
Provider Middle Name	D
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.
Provider Credential Text	PSY
	The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	2000
	Individual professional's medical school graduation year
Primary Specialty	PSYCHOLOGIST, CLINICAL
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	609 MAIN ST
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 3
	Group Practice or individual's line 2 address
City	SOUTH PORTLAND
	Group Practice or individual's city
State	ME
	Group Practice or individual's state
Zip Code	041065470
	Group Practice or individual's zip code (9 digits when available)
Phone Number	2077752220
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y