Dr. Betsy Fernbach LLC

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

35SI00225700 Issued in NJ

Legal business name

DR. BETSY FERNBACH LLC

Practice address

1101 Kings Hwy N
Suite 202
Cherry Hill, NJ 08034-1912

Phone

(609) 238-1751

NPI assigned

Sep 9, 2015

Organization subpart

No

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

Authorized official

Name

Dr. Betsy Fernbach, PSY.D.NPI 1144385824

Title

Licensed Psychologist

Phone

(609) 238-1751

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in PA

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Betsy Ellen Fernbach, PSY.D.

  • Psychologist
  • Mount Laurel, NJ
  • NPI 1144385824

  PA

  Medicare reassignment Authorized official
• Beatrice Bock, LCSW

  • Clinical Social Worker
  • Marlton, NJ
  • NPI 1144396540
  NPD (past)

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

{
    "created_epoch": "1441756800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1441756800000",
    "number": "1922476811",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1101 KINGS HWY N",
            "address_2": "SUITE 202",
            "city": "CHERRY HILL",
            "state": "NJ",
            "postal_code": "080341912",
            "telephone_number": "609-238-1751"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1101 KINGS HWY N",
            "address_2": "SUITE 202",
            "city": "CHERRY HILL",
            "state": "NJ",
            "postal_code": "080341912",
            "telephone_number": "609-238-1751"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR. BETSY FERNBACH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-09-09",
        "last_updated": "2015-09-09",
        "status": "A",
        "authorized_official_last_name": "FERNBACH",
        "authorized_official_first_name": "BETSY",
        "authorized_official_title_or_position": "LICENSED PSYCHOLOGIST",
        "authorized_official_telephone_number": "609-238-1751",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSY.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "NJ",
            "license": "35SI00225700",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Psychologist in Cherry Hill, NJ
• Providers in Cherry Hill, NJ by specialty
• Clinical Psychologist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.