Provider Demographics
NPI:1770933392
Name:BADER, FREDERICK CHARLES (PSYD)
Entity type:Individual
Prefix:
First Name:FREDERICK
Middle Name:CHARLES
Last Name:BADER
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1231 NORTH BROAD STREET
Mailing Address - Street 2:5TH FLOOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19122
Mailing Address - Country:US
Mailing Address - Phone:215-627-8671
Mailing Address - Fax:215-763-5774
Practice Address - Street 1:1231 NORTH BROAD STREET
Practice Address - Street 2:5TH FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19122
Practice Address - Country:US
Practice Address - Phone:215-627-8671
Practice Address - Fax:215-763-5774
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-14
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS008795L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist