Provider Demographics
NPI:1871727248
Name:NAYDOCK, GERD RALPH (LSW)
Entity type:Individual
Prefix:MR
First Name:GERD
Middle Name:RALPH
Last Name:NAYDOCK
Suffix:
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 CARROLL RD
Mailing Address - Street 2:
Mailing Address - City:WYNNEWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19096-4001
Mailing Address - Country:US
Mailing Address - Phone:484-412-8101
Mailing Address - Fax:
Practice Address - Street 1:900 CARROLL RD
Practice Address - Street 2:
Practice Address - City:WYNNEWOOD
Practice Address - State:PA
Practice Address - Zip Code:19096-4001
Practice Address - Country:US
Practice Address - Phone:484-412-8101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-13
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35S100576400103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical