Provider Demographics
NPI:1083831333
Name:JALBERT, RONALD GASTON (PHD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:GASTON
Last Name:JALBERT
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4716 ELLSWORTH AVE
Mailing Address - Street 2:SUITE 211
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15213-2851
Mailing Address - Country:US
Mailing Address - Phone:412-683-8856
Mailing Address - Fax:412-781-6820
Practice Address - Street 1:4716 ELLSWORTH AVE
Practice Address - Street 2:SUITE 211
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15213-2851
Practice Address - Country:US
Practice Address - Phone:412-683-8856
Practice Address - Fax:412-781-6820
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS004809L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA053180Medicare ID - Type Unspecified