Gerald T O'Brien, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PS004240L Issued in PA

Practice address

112 Bala Ave
Bala Cynwyd, PA 19004-3025

Phone

(610) 667-6490

Fax

(610) 667-1744

NPI assigned

Aug 2, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154476800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1259884800000",
    "number": "1164439808",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "112 BALA AVE",
            "city": "BALA CYNWYD",
            "state": "PA",
            "postal_code": "190043025",
            "telephone_number": "610-667-6490",
            "fax_number": "610-667-1744"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "112 BALA AVE",
            "city": "BALA CYNWYD",
            "state": "PA",
            "postal_code": "190043025",
            "telephone_number": "610-667-6490",
            "fax_number": "610-667-1744"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "O'BRIEN",
        "first_name": "GERALD",
        "middle_name": "T",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-02",
        "last_updated": "2009-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "PA",
            "license": "PS004240L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUESHIELD",
            "identifier": "OB022399",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAGELLAN BEHAVIORAL HEALT",
            "identifier": "097182000",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Clinical Psychologist in Bala Cynwyd, PA
• Providers in Bala Cynwyd, PA by specialty
• Clinical Psychologist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.