Individual
DR. JOHN WESLEY ADDIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
23 KENNEDY STREET, SUITE 202, BRADFORD, PA 16701-2005
(814) 362-2136
(814) 362-2136
Mailing address
23 KENNEDY STREET, SUITE 202, BRADFORD, PA 16701-2005
(814) 362-2136
(814) 362-2468
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PS002352L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0004277250
AETNA
PA
01
—
00050141001
HMO
PA
01
—
000507570001
BCBS OF WNY
NY
01
—
031013
BCBS
PA
01
—
1415000
MEGALLAN
PA
01
—
6803636
VALUE OPTIONS
PA
01
—
P009953
TRICARE
PA
Enumeration date
12/04/2007
Last updated
12/04/2007
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