Provider Demographics
NPI:1639299449
Name:AUERBACH, JEFF T (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JEFF
Middle Name:T
Last Name:AUERBACH
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 S DELHI ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19147-3810
Mailing Address - Country:US
Mailing Address - Phone:610-446-4943
Mailing Address - Fax:
Practice Address - Street 1:688 KNOWLES AVE
Practice Address - Street 2:UNIT C
Practice Address - City:SOUTHAMPTON
Practice Address - State:PA
Practice Address - Zip Code:18966-4102
Practice Address - Country:US
Practice Address - Phone:215-364-3722
Practice Address - Fax:215-968-9034
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS008228L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2019139000OtherIBX