Provider Demographics
NPI:1316375355
Name:BARE, JEFFREY (MAMFT, LMFT)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:
Last Name:BARE
Suffix:
Gender:M
Credentials:MAMFT, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 W MAIN ST UNIT F1
Mailing Address - Street 2:
Mailing Address - City:SALUNGA
Mailing Address - State:PA
Mailing Address - Zip Code:17538-1109
Mailing Address - Country:US
Mailing Address - Phone:717-875-6322
Mailing Address - Fax:717-653-5217
Practice Address - Street 1:101 W MAIN ST UNIT F1
Practice Address - Street 2:
Practice Address - City:SALUNGA
Practice Address - State:PA
Practice Address - Zip Code:17538-1109
Practice Address - Country:US
Practice Address - Phone:717-875-6322
Practice Address - Fax:717-653-5217
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-30
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMF000723174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist