Healthcare Provider Details

I. General information

NPI: 1720545700
Provider Name (Legal Business Name): CAITLIN KILMER PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2019
Last Update Date: 02/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 S BROAD ST STE 1700
PHILADELPHIA PA
19110-1007
US

IV. Provider business mailing address

226 HONEY LOCUST DR
AVONDALE PA
19311-9804
US

V. Phone/Fax

Practice location:
  • Phone: 215-701-1560
  • Fax:
Mailing address:
  • Phone: 610-457-9880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSS018574
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: