Provider Demographics
NPI:1114983137
Name:GERHARD, JACK (MS CAC DIPLOMAT)
Entity Type:Individual
Prefix:MR
First Name:JACK
Middle Name:
Last Name:GERHARD
Suffix:
Gender:M
Credentials:MS CAC DIPLOMAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 SEEM ST
Mailing Address - Street 2:
Mailing Address - City:EMMAUS
Mailing Address - State:PA
Mailing Address - Zip Code:18049-2613
Mailing Address - Country:US
Mailing Address - Phone:610-965-8485
Mailing Address - Fax:610-965-7851
Practice Address - Street 1:125 SEEM ST
Practice Address - Street 2:
Practice Address - City:EMMAUS
Practice Address - State:PA
Practice Address - Zip Code:18049-2613
Practice Address - Country:US
Practice Address - Phone:610-965-8485
Practice Address - Fax:610-965-7851
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS006771L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist