Healthcare Provider Details

I. General information

NPI: 1336100387
Provider Name (Legal Business Name): VALLEY PSYCHOLOGICAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2006
Last Update Date: 09/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1045 S CEDAR CREST BLVD
ALLENTOWN PA
18103-5443
US

IV. Provider business mailing address

1045 S CEDAR CREST BLVD
ALLENTOWN PA
18103-5443
US

V. Phone/Fax

Practice location:
  • Phone: 610-433-3360
  • Fax: 610-432-3110
Mailing address:
  • Phone: 610-433-3360
  • Fax: 610-432-3110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPS004698L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPS007168L
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS004698L
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS002825L
License Number StatePA

VIII. Authorized Official

Name: DR. JAMES KINS MARGOLIS
Title or Position: PSYCHOLOGIST
Credential: PH.D.
Phone: 610-433-3360