Provider Demographics
NPI:1528276714
Name:LINDBLAD-GOLDBERG, MARION (PHD)
Entity type:Individual
Prefix:DR
First Name:MARION
Middle Name:
Last Name:LINDBLAD-GOLDBERG
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7304 ELBOW LN
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19119-2809
Mailing Address - Country:US
Mailing Address - Phone:215-247-6992
Mailing Address - Fax:
Practice Address - Street 1:7304 ELBOW LN
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19119-2809
Practice Address - Country:US
Practice Address - Phone:215-247-6992
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPSY000105103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist