Provider Demographics
NPI:1982770731
Name:MESHBERG, EDWARD MARK (PH D)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:MARK
Last Name:MESHBERG
Suffix:
Gender:M
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 H ST STE 201A
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-5136
Mailing Address - Country:US
Mailing Address - Phone:661-633-1890
Mailing Address - Fax:661-633-1890
Practice Address - Street 1:1601 H ST STE 201A
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-5136
Practice Address - Country:US
Practice Address - Phone:661-633-1890
Practice Address - Fax:661-633-1890
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 18030103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical