Healthcare Provider Details

I. General information

NPI: 1790510725
Provider Name (Legal Business Name): CAITLIN CHUN-KENNEDY PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2024
Last Update Date: 09/09/2024
Certification Date: 09/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2007 PARK FOREST AVE
STATE COLLEGE PA
16803-1333
US

IV. Provider business mailing address

2007 PARK FOREST AVE
STATE COLLEGE PA
16803-1333
US

V. Phone/Fax

Practice location:
  • Phone: 717-321-3675
  • Fax:
Mailing address:
  • Phone: 717-321-3675
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPS019157
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: