Provider Demographics
NPI:1689858193
Name:SPRINGER, JOAN BACON (MA)
Entity Type:Individual
Prefix:MRS
First Name:JOAN
Middle Name:BACON
Last Name:SPRINGER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MS
Other - First Name:JOAN
Other - Middle Name:S
Other - Last Name:BACON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:14 MACUNGIE AVE
Mailing Address - Street 2:
Mailing Address - City:EMMAUS
Mailing Address - State:PA
Mailing Address - Zip Code:18049-2213
Mailing Address - Country:US
Mailing Address - Phone:610-928-3400
Mailing Address - Fax:610-928-3500
Practice Address - Street 1:14 MACUNGIE AVE
Practice Address - Street 2:
Practice Address - City:EMMAUS
Practice Address - State:PA
Practice Address - Zip Code:18049-2213
Practice Address - Country:US
Practice Address - Phone:610-928-3400
Practice Address - Fax:610-928-3500
Is Sole Proprietor?:No
Enumeration Date:2007-12-19
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS 007690L103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist