Active NPI
Betsy Ellen Fernbach, PSY.D.
- Psychologist
- Mount Laurel, NJ
National Provider Identifier
1144385824
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 35SI00225700
- Practice address
- 1155 Route 73
Ramblewood Center, Suite 18
Mount Laurel, NJ 08054-2352 - Phone
- (856) 273-0789
- NPI assigned
- Dec 24, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 35SI00225700 | NJ | Primary |
Addresses
Primary practice location
1155 Route 73
Ramblewood Center, Suite 18
Mount Laurel, NJ 08054-2352
Mailing address
1155 Route 73
Ramblewood Center, Suite 18
Mount Laurel, NJ 08054-2352
Phone (856) 273-0789
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 130367000 | Other | NJ | MAGELLAN MANAGED CARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NJ, PA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 2
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- Other, 1984
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
Practice addresses (Care Compare)
1 Bala Ave
Suite 125
Bala Cynwyd, PA 19004-3217
Phone (609) 238-1751
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1166918400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1144385824",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1155 ROUTE 73",
"address_2": "RAMBLEWOOD CENTER, SUITE 18",
"city": "MOUNT LAUREL",
"state": "NJ",
"postal_code": "080542352",
"telephone_number": "856-273-0789"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1155 ROUTE 73",
"address_2": "RAMBLEWOOD CENTER, SUITE 18",
"city": "MOUNT LAUREL",
"state": "NJ",
"postal_code": "080542352",
"telephone_number": "856-273-0789"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FERNBACH",
"first_name": "BETSY",
"middle_name": "ELLEN",
"name_prefix": "Dr.",
"credential": "PSY.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-12-24",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "NJ",
"license": "35SI00225700",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MAGELLAN MANAGED CARE",
"identifier": "130367000",
"state": "NJ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Mount Laurel, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.