Individual
DR. JERROLD C. EDELBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
280B GANNETT DR, SOUTH PORTLAND, ME 04106-6940
(207) 828-0048
(207) 772-3743
Mailing address
280B GANNETT DR, SOUTH PORTLAND, ME 04106-6940
(207) 828-0048
(207) 772-3743
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PS561
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1053467779
—
ME
Enumeration date
10/21/2009
Last updated
11/06/2013
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