Individual
DR. BETSY ELLEN FERNBACH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSY.D.
Contact information
Practice address
1155 ROUTE 73, RAMBLEWOOD CENTER, SUITE 18, MOUNT LAUREL, NJ 08054-2352
(856) 273-0789
Mailing address
1155 ROUTE 73, RAMBLEWOOD CENTER, SUITE 18, MOUNT LAUREL, NJ 08054-2352
(856) 273-0789
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
35SI00225700
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
130367000
MAGELLAN MANAGED CARE
NJ
Enumeration date
12/24/2006
Last updated
07/08/2007
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