Provider Demographics
NPI:1881814663
Name:EIDELSON, ROY JOSEPH (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROY
Middle Name:JOSEPH
Last Name:EIDELSON
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 1:413 PEMBROKE RD
Mailing Address - Street 2:
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-2724
Mailing Address - Country:US
Mailing Address - Phone:610-668-4684
Mailing Address - Fax:
Practice Address - Street 1:29 BALA AVE
Practice Address - Street 2:
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-3209
Practice Address - Country:US
Practice Address - Phone:610-513-8685
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS003894L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist