Healthcare Provider Details

I. General information

NPI: 1578016960
Provider Name (Legal Business Name): KATHLEEN NOELLE CHILDS PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2016
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3538 ROUTE 309 UNIT 1
OREFIELD PA
18069-2074
US

IV. Provider business mailing address

3538 ROUTE 309 UNIT 1
OREFIELD PA
18069-2074
US

V. Phone/Fax

Practice location:
  • Phone: 484-238-0440
  • Fax: 833-706-3878
Mailing address:
  • Phone: 484-238-0440
  • Fax: 833-706-3878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPS018618
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: