Provider Demographics
NPI:1336368323
Name:BLEIBERG, JAMES R (PSY D)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:R
Last Name:BLEIBERG
Suffix:
Gender:M
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 POWDER MILL LN
Mailing Address - Street 2:
Mailing Address - City:WYNNEWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19096-2617
Mailing Address - Country:US
Mailing Address - Phone:610-416-4806
Mailing Address - Fax:
Practice Address - Street 1:950 E HAVERFORD RD
Practice Address - Street 2:SUITE 300
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-3850
Practice Address - Country:US
Practice Address - Phone:610-416-4806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS009061L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA039106Medicare ID - Type Unspecified