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General NPI Number Information
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NPI Number | 1154589893
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Entity Type | Organization
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Legal Business Name | WILLIAMSPORT PSYCHOLOGICAL ASSOCIATES
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Dates
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Enumeration Date | 05/29/2008
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Last Update Date | 05/29/2008
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Provider Practice Location Address
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Address Line | 811 MARKET ST
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City | WILLIAMSPORT
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State | PA
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Zip | 17701-3402
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Country | US
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Telephone | 570-322-2603
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Fax | 570-322-4208
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Provider Business Mailing Address
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Address Line | 811 MARKET ST
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City | WILLIAMSPORT
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State | PA
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Zip | 17701-3402
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Country | US
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Telephone | 570-322-2603
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Fax | 570-322-4208
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DR. JOHN W KELSEY
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Credential | PH.D
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Telephone | 570-322-2603
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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