| Anxiety & Agoraphobia Treatment Center, Pc | |
|
112 Bala Ave Bala Cynwyd PA 19004-3025 | |
| (610) 667-6490 | |
| (610) 667-1744 |
| Full Name | Anxiety & Agoraphobia Treatment Center, Pc |
|---|---|
| Speciality | Psychologist |
| Location | 112 Bala Ave, Bala Cynwyd, Pennsylvania |
| Authorized Official Name and Position | Barbara J Foster-daley (ADMINISTRATOR) |
| Authorized Official Contact | 6106676490 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Anxiety & Agoraphobia Treatment Center, Pc 112 Bala Ave Bala Cynwyd PA 19004-3025 Ph: (610) 667-6490 | Anxiety & Agoraphobia Treatment Center, Pc 112 Bala Ave Bala Cynwyd PA 19004-3025 Ph: (610) 667-6490 |
| NPI Number | 1912015603 |
|---|---|
| Provider Enumeration Date | 08/25/2006 |
| Last Update Date | 02/08/2011 |
| Medicare PECOS PAC ID | 5294915708 |
|---|---|
| Medicare Enrollment ID | O20110215000687 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912015603 | NPI | - | NPPES |
| 027365000 | Other | MAGELLAN BEHAVIORAL HEALT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Secondary |
| Provider Name | Gerald T O'brien |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1164439808 PECOS PAC ID: 9638359169 Enrollment ID: I20110215000828 |
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