Provider Demographics
NPI:1083836712
Name:GERBNER, THOMAS J (PHD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:J
Last Name:GERBNER
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 1:120 ELLIS RD
Mailing Address - Street 2:
Mailing Address - City:HAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19083-1109
Mailing Address - Country:US
Mailing Address - Phone:610-449-7757
Mailing Address - Fax:610-449-1848
Practice Address - Street 1:15 PRESIDENTIAL BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-1006
Practice Address - Country:US
Practice Address - Phone:610-667-7667
Practice Address - Fax:610-667-7364
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS-005783-L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA665133Medicare ID - Type UnspecifiedPSYCHOLOGIST