Provider Demographics
NPI:1831314038
Name:EDWARD J. LUNDEEN, PH.D.
Entity Type:Organization
Organization Name:EDWARD J. LUNDEEN, PH.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:LUNDEEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:610-820-8499
Mailing Address - Street 1:2245 WALBERT AVE
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-1358
Mailing Address - Country:US
Mailing Address - Phone:610-820-8499
Mailing Address - Fax:810-820-0311
Practice Address - Street 1:2245 WALBERT AVE
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-1358
Practice Address - Country:US
Practice Address - Phone:610-820-8499
Practice Address - Fax:810-820-0311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPA006798L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA741501Medicare ID - Type UnspecifiedPSYCHOLOGIST