Provider Demographics
NPI:1194884015
Name:VANGUARD PSYCHOLOGICAL ASSOCIATES, P.C.
Entity type:Organization
Organization Name:VANGUARD PSYCHOLOGICAL ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:BERGMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:215-233-4350
Mailing Address - Street 1:620 E. WILLOW GROVE AVENUE
Mailing Address - Street 2:
Mailing Address - City:WYNDMOOR
Mailing Address - State:PA
Mailing Address - Zip Code:19038-7949
Mailing Address - Country:US
Mailing Address - Phone:215-233-4350
Mailing Address - Fax:215-233-4404
Practice Address - Street 1:620 E. WILLOW GROVE AVENUE
Practice Address - Street 2:
Practice Address - City:WYNDMOOR
Practice Address - State:PA
Practice Address - Zip Code:19038-7949
Practice Address - Country:US
Practice Address - Phone:215-233-4350
Practice Address - Fax:215-233-4404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA0816369103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty