Provider Demographics
NPI:1396309100
Name:BERTIER, JEAN LUC
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:LUC
Last Name:BERTIER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 CRAWFORD AVE
Mailing Address - Street 2:
Mailing Address - City:LANSDOWNE
Mailing Address - State:PA
Mailing Address - Zip Code:19050-1404
Mailing Address - Country:US
Mailing Address - Phone:484-321-1388
Mailing Address - Fax:
Practice Address - Street 1:220 CRAWFORD AVE
Practice Address - Street 2:
Practice Address - City:LANSDOWNE
Practice Address - State:PA
Practice Address - Zip Code:19050-1404
Practice Address - Country:US
Practice Address - Phone:484-321-1388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-26
Last Update Date:2019-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health