Provider Demographics
NPI:1013977032
Name:BATISTA, EDWARD STEPHEN (PHD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:STEPHEN
Last Name:BATISTA
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 1:3920 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:CAMP HILL
Mailing Address - State:PA
Mailing Address - Zip Code:17011-4202
Mailing Address - Country:US
Mailing Address - Phone:717-737-7332
Mailing Address - Fax:717-737-2732
Practice Address - Street 1:3920 MARKET ST
Practice Address - Street 2:
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-4202
Practice Address - Country:US
Practice Address - Phone:717-737-7332
Practice Address - Fax:717-737-2732
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-24
Last Update Date:2010-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS000164L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA6000017Medicaid
PAR05724Medicare UPIN
PA6000017Medicaid