MEDICARE: DR. KATHLEEN MARY-ZELIS LEDERMANN PSY.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PS018211	PA

General Provider Information

NPI Number	:	1356869739
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KATHLEEN MARY-ZELIS LEDERMANN PSY.D.

Provider Business Mailing Address
First Line	:	353 PARK AVE
Second Line	:
City	:	NEW CUMBERLAND
State	:	PA
Zip	:	17070-1345
Country	:	US
Telephone Number	:	717-576-9401
Fax Number	:

Provider Business Practice Location Address
First Line	:	120 S FILBERT ST
Second Line	:
City	:	MECHANICSBURG
State	:	PA
Zip	:	17055-6593
Country	:	US
Telephone Number	:	717-458-5788
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/06/2017
Last Update Date	:	09/27/2017

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