Provider Demographics
NPI:1194870535
Name:MARILYN BERGMAN & JUDITH SHECHTER, PTR
Entity type:Organization
Organization Name:MARILYN BERGMAN & JUDITH SHECHTER, PTR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:
Authorized Official - Last Name:SHECHTER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:610-642-2353
Mailing Address - Street 1:308 E LANCASTER AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WYNNEWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19096-2145
Mailing Address - Country:US
Mailing Address - Phone:610-642-2353
Mailing Address - Fax:610-642-3278
Practice Address - Street 1:308 E LANCASTER AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:WYNNEWOOD
Practice Address - State:PA
Practice Address - Zip Code:19096-2145
Practice Address - Country:US
Practice Address - Phone:610-642-2353
Practice Address - Fax:610-642-3278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA197408OtherMEDICARE PTAN