MEDICARE: SUPPORTING KIDDS

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1891014460
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUPPORTING KIDDS

Provider Business Mailing Address
First Line	:	1213 OLD LANCASTER PIKE
Second Line	:
City	:	HOCKESSIN
State	:	DE
Zip	:	19707-9560
Country	:	US
Telephone Number	:	302-235-5544
Fax Number	:	302-235-2672

Provider Business Practice Location Address
First Line	:	1213 OLD LANCASTER PIKE
Second Line	:
City	:	HOCKESSIN
State	:	DE
Zip	:	19707-9560
Country	:	US
Telephone Number	:	302-235-5544
Fax Number	:	302-235-2672

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	DR. STEPHANIE TRAYNOR
Credential	:	PSYD, MBA
Telephone Number	:	302-235-5544

Provider Enumeration Date	:	05/21/2010
Last Update Date	:	05/21/2010

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Directions to “SUPPORTING KIDDS ” Practice Location

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