Provider Demographics
NPI:1437273869
Name:WASHINGTON PSYCHOLOGICAL SERVICES
Entity Type:Organization
Organization Name:WASHINGTON PSYCHOLOGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:BOBROW
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:856-589-4147
Mailing Address - Street 1:PO BOX 8161
Mailing Address - Street 2:
Mailing Address - City:TURNERSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08012-8161
Mailing Address - Country:US
Mailing Address - Phone:856-589-4147
Mailing Address - Fax:856-589-3805
Practice Address - Street 1:100 HERITAGE VALLEY DR STE 1
Practice Address - Street 2:
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080-1752
Practice Address - Country:US
Practice Address - Phone:856-589-4147
Practice Address - Fax:856-589-3805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1624103TC0700X
NJMA0277852084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ056493Medicare PIN