Provider Demographics
NPI:1548479629
Name:GERARDI, DOUGLAS LEONARD (PHD)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:LEONARD
Last Name:GERARDI
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 SOUTH INDEPENDENCE MALL EAST
Mailing Address - Street 2:BOURSE BUILDING , SUITE # 968
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19106-2515
Mailing Address - Country:US
Mailing Address - Phone:215-888-0317
Mailing Address - Fax:
Practice Address - Street 1:111 S INDEPENDENCE MALL E
Practice Address - Street 2:BOURSE BUILDING , SUITE # 968
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19106-2515
Practice Address - Country:US
Practice Address - Phone:215-888-0317
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS003108103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical