Provider Demographics
NPI:1871663658
Name:DIVERSIFIED PSYCHCARE ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:DIVERSIFIED PSYCHCARE ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:J
Authorized Official - Last Name:BERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-527-6555
Mailing Address - Street 1:PO BOX 693
Mailing Address - Street 2:
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-0693
Mailing Address - Country:US
Mailing Address - Phone:610-527-6555
Mailing Address - Fax:610-527-7248
Practice Address - Street 1:234 S BRYN MAWR AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-2133
Practice Address - Country:US
Practice Address - Phone:610-527-6555
Practice Address - Fax:610-527-7248
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-037544-E2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty