Provider Demographics
NPI:1205434123
Name:GEBHART, ANDREW STEPHEN (MA, BSC)
Entity type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:STEPHEN
Last Name:GEBHART
Suffix:
Gender:M
Credentials:MA, BSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 ESSEX CT
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19711-2988
Mailing Address - Country:US
Mailing Address - Phone:302-256-8715
Mailing Address - Fax:
Practice Address - Street 1:1 ESSEX CT
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19711-2988
Practice Address - Country:US
Practice Address - Phone:302-256-8715
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-13
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH004664106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician