Provider Demographics
NPI:1053883264
Name:BIRNBAUM, ASPEN HAYLEY
Entity type:Individual
Prefix:
First Name:ASPEN
Middle Name:HAYLEY
Last Name:BIRNBAUM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:242 SUMMIT TRACE RD
Mailing Address - Street 2:
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19047-1069
Mailing Address - Country:US
Mailing Address - Phone:215-400-0183
Mailing Address - Fax:
Practice Address - Street 1:702 FLORAL VALE BLVD # 602
Practice Address - Street 2:
Practice Address - City:YARDLEY
Practice Address - State:PA
Practice Address - Zip Code:19067-5529
Practice Address - Country:US
Practice Address - Phone:215-704-9224
Practice Address - Fax:866-455-9086
Is Sole Proprietor?:No
Enumeration Date:2018-12-28
Last Update Date:2018-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA1-18-33021103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst