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NPI Code Detail

MEDICARE: DR. JONATHAN GERSHON PHD

MEDICARE: DR. JONATHAN GERSHON 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
1103TC0700XClinical PsychologistPS00833RI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10000027348OTHERRIRI BLUE CROSS PROVIDER #
2411605OTHERRIRI BLUE CHIP PROVIDER #
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1962528406
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JONATHAN GERSHON PHD
Provider Business Mailing Address
First Line : 4800 N SCOTTSDALE RD STE 2500
Second Line :
City : SCOTTSDALE
State : AZ
Zip : 85251-7630
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 400 BALD HILL RD STE 530
Second Line :
City : WARWICK
State : RI
Zip : 02886-6111
Country : US
Telephone Number : 401-349-3131
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/22/2007
Last Update Date : 05/04/2026

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