Provider Demographics
NPI:1588607196
Name:SADAR, MITCHELL M (PHD)
Entity Type:Individual
Prefix:
First Name:MITCHELL
Middle Name:M
Last Name:SADAR
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 1:124 WOODLYN AVE
Mailing Address - Street 2:
Mailing Address - City:TROOPER
Mailing Address - State:PA
Mailing Address - Zip Code:19403-1608
Mailing Address - Country:US
Mailing Address - Phone:610-933-9440
Mailing Address - Fax:610-933-8567
Practice Address - Street 1:1288 VALLEY FORGE RD.
Practice Address - Street 2:SUITE 72
Practice Address - City:VALLEY FORGE
Practice Address - State:PA
Practice Address - Zip Code:19482
Practice Address - Country:US
Practice Address - Phone:610-933-9440
Practice Address - Fax:610-933-8567
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS-004097L103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA163422S91Medicare ID - Type Unspecified