Provider Demographics
NPI:1356986319
Name:THREE DIRTY BIRDS LLC
Entity type:Organization
Organization Name:THREE DIRTY BIRDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:J
Authorized Official - Last Name:BENDIG
Authorized Official - Suffix:JR
Authorized Official - Credentials:PHD/ABD, LPC
Authorized Official - Phone:610-543-4048
Mailing Address - Street 1:PO BOX 330
Mailing Address - Street 2:
Mailing Address - City:SWARTHMORE
Mailing Address - State:PA
Mailing Address - Zip Code:19081-0330
Mailing Address - Country:US
Mailing Address - Phone:610-543-4048
Mailing Address - Fax:
Practice Address - Street 1:805 LORRAINE DR
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:PA
Practice Address - Zip Code:19064-1004
Practice Address - Country:US
Practice Address - Phone:610-543-4048
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-14
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty