Provider Demographics
NPI:1518010644
Name:HEBEISEN, THOMAS JEFFREY (PHD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:JEFFREY
Last Name:HEBEISEN
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 1:208 SKYCREST DR
Mailing Address - Street 2:
Mailing Address - City:LANDENBERG
Mailing Address - State:PA
Mailing Address - Zip Code:19350-9658
Mailing Address - Country:US
Mailing Address - Phone:610-274-0641
Mailing Address - Fax:610-274-0351
Practice Address - Street 1:208 SKYCREST DR
Practice Address - Street 2:
Practice Address - City:LANDENBERG
Practice Address - State:PA
Practice Address - Zip Code:19350-9658
Practice Address - Country:US
Practice Address - Phone:610-274-0641
Practice Address - Fax:610-274-0351
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS004192L103TC0700X
DEB1-0000192103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA00351324OtherCAQH
PA2052606OtherCIGNA
PAV686SOtherEMPIRE
PA112546OtherVALUE OPTIONS