Individual
DR. JONATHAN DAVID BIRNBERG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
609 MAIN ST, SUITE 3, SOUTH PORTLAND, ME 04106-5453
(207) 775-2220
(207) 775-2226
Mailing address
332 POOL ST, BIDDEFORD, ME 04005-9713
(207) 775-2220
(207) 775-2226
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
8077
MA
103T00000X
Psychologist
Primary
PS1192
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0005266
MEDICARE PTAN
ME
01
—
808393000
MAGELLAN
MA
01
—
W06273
BCBS OF MASS.
MA
Enumeration date
01/15/2007
Last updated
10/13/2020
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