Provider Demographics
NPI:1871631572
Name:ANDERSON, ERIC EDWARD (PHD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:EDWARD
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 S BRYN MAWR AVE
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-2005
Mailing Address - Country:US
Mailing Address - Phone:610-519-1793
Mailing Address - Fax:610-519-1795
Practice Address - Street 1:715 S BRYN MAWR AVE
Practice Address - Street 2:SUITE 1000
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-2005
Practice Address - Country:US
Practice Address - Phone:610-519-1793
Practice Address - Fax:610-519-1795
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY28349103TC0700X
PAPS015071103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist