Provider Demographics
NPI:1386774438
Name:NERENBERG, ALYSON (PSYD)
Entity type:Individual
Prefix:
First Name:ALYSON
Middle Name:
Last Name:NERENBERG
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 MONTICELLO LN
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH MEETING
Mailing Address - State:PA
Mailing Address - Zip Code:19462-1274
Mailing Address - Country:US
Mailing Address - Phone:610-828-9337
Mailing Address - Fax:
Practice Address - Street 1:510 MONTICELLO LN
Practice Address - Street 2:
Practice Address - City:PLYMOUTH MEETING
Practice Address - State:PA
Practice Address - Zip Code:19462-1274
Practice Address - Country:US
Practice Address - Phone:610-828-9337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2012-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS008867L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2062524000OtherINDEPENDENCE BLUE CROSS
PA1370739OtherHIGHMARK BLUE SHIELD
PA2062524000OtherINDEPENDENCE BLUE CROSS
PA1370739OtherHIGHMARK BLUE SHIELD