MEDICARE: SOL BARENBAUM PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PS-002669-L	PA
2	103T00000X	Psychologist	PS-002669-L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	185860	OTHER	PA	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1750462313
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SOL BARENBAUM PHD

Provider Business Mailing Address
First Line	:	2927 MIDVALE AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19129-1025
Country	:	US
Telephone Number	:	215-848-6968
Fax Number	:

Provider Business Practice Location Address
First Line	:	1528 WALNUT ST
Second Line	:	SUITE 2025
City	:	PHILADELPHIA
State	:	PA
Zip	:	19102-3604
Country	:	US
Telephone Number	:	215-848-6968
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/18/2006
Last Update Date	:	11/08/2007

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Directions to “ SOL BARENBAUM PHD” Practice Location

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