Provider Demographics
NPI:1821153099
Name:UBER, JOHN WILLIAM (PHD)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:WILLIAM
Last Name:UBER
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 1:425 LIBERTY STREET
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:PA
Mailing Address - Zip Code:16127-2206
Mailing Address - Country:US
Mailing Address - Phone:724-974-1513
Mailing Address - Fax:724-458-5929
Practice Address - Street 1:425 LIBERTY STREET
Practice Address - Street 2:
Practice Address - City:GROVE CITY
Practice Address - State:PA
Practice Address - Zip Code:16127-2206
Practice Address - Country:US
Practice Address - Phone:724-974-1513
Practice Address - Fax:724-458-5929
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2010-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC000106101YM0800X
PAPS016458103T00000X, 103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling