Provider Demographics
NPI:1538289673
Name:SADIGH, MICAH (PHD)
Entity Type:Individual
Prefix:DR
First Name:MICAH
Middle Name:
Last Name:SADIGH
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 1:850 S 5TH ST
Mailing Address - Street 2:GOOD SHEPHERD PSYCHOLOGY GROUP
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-3308
Mailing Address - Country:US
Mailing Address - Phone:610-776-3594
Mailing Address - Fax:
Practice Address - Street 1:850 S 5TH ST
Practice Address - Street 2:GOOD SHEPHERD PSYCHOLOGY GROUP
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-3308
Practice Address - Country:US
Practice Address - Phone:610-776-3594
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2007-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS006029103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA630922NB0OtherMEDICARE
PA1568536480OtherGROUP
PA630922NB0OtherMEDICARE
PA1568536480OtherGROUP