Provider Demographics
NPI:1831309954
Name:BOPP, MICHAEL JOSEPH (PHD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOSEPH
Last Name:BOPP
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 1:191 PRESIDENTIAL BLVD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-1207
Mailing Address - Country:US
Mailing Address - Phone:610-664-8209
Mailing Address - Fax:610-668-1547
Practice Address - Street 1:191 PRESIDENTIAL BLVD
Practice Address - Street 2:SUITE 106
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-1207
Practice Address - Country:US
Practice Address - Phone:610-664-8209
Practice Address - Fax:610-668-1547
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS003875L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist