Provider Demographics
NPI:1023220571
Name:DEBIAK, DENNIS MICHAEL (PSYD)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:MICHAEL
Last Name:DEBIAK
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 S CHESTER RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:SWARTHMORE
Mailing Address - State:PA
Mailing Address - Zip Code:19081-1803
Mailing Address - Country:US
Mailing Address - Phone:610-690-2442
Mailing Address - Fax:610-499-4625
Practice Address - Street 1:300 S CHESTER RD
Practice Address - Street 2:SUITE 106
Practice Address - City:SWARTHMORE
Practice Address - State:PA
Practice Address - Zip Code:19081-1803
Practice Address - Country:US
Practice Address - Phone:610-690-2442
Practice Address - Fax:610-499-4625
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS008437L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000512Medicare ID - Type Unspecified