Edelberg, Jerrold C.
Edelberg, Jerrold C. is an individual health care provider with primary practice located at 280B Gannett Dr , South Portland ME 04106-6940. He recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as his primary health care specialty. Edelberg, Jerrold C. can be contacted via phone (207) 828-0048.Contact Information
Primary practice address
280B Gannett Dr
South Portland ME 04106-6940
Phone: (207) 828-0048
Fax: (207) 772-3743
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Clinical | 103TC0700X | PS561 | Maine |
Profile Details
| NPI number | 1619203973 |
|---|---|
| LBN Legal business name | Edelberg, Jerrold C. |
| Credentials | PH.D. |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Oct 21st, 2009 |
| Last updated | Nov 6th, 2013 - about 12 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1619203973 | NPPES |
| Maine | MEDICAID | 1053467779 |
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