Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | PS004893L | PA |
NPI | 1043708910 |
---|---|
Provider Name | Dr. John Joseph Bearoff JR. |
First Address | Norristown, PA 19401-1902 |
Second Address | Norristown, PA 19401-1902 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2018 |
Last Update Date | 26/04/2018 |