Healthcare Provider Details

I. General information

NPI: 1154015055
Provider Name (Legal Business Name): ELIZABETH ANNE KAPLAN KAHN PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZABETH ANNE KAPLAN-KAHN PHD

II. Dates (important events)

Enumeration Date: 06/05/2023
Last Update Date: 06/05/2023
Certification Date: 06/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 CIVIC CENTER BLVD
PHILADELPHIA PA
19104-4395
US

IV. Provider business mailing address

2716 SOUTH ST FL 5
PHILADELPHIA PA
19146-2305
US

V. Phone/Fax

Practice location:
  • Phone: 267-854-6035
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS019596
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License NumberPS019596
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPS019596
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: