Provider Demographics
NPI:1073892808
Name:KILLPACK, CHAD (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CHAD
Middle Name:
Last Name:KILLPACK
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:CHAD
Other - Middle Name:
Other - Last Name:KILLPACK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:48 MDG UNIT 5115
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09461
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:48 MDG UNIT 5115
Practice Address - Street 2:EDIS
Practice Address - City:APO
Practice Address - State:NY
Practice Address - Zip Code:09461
Practice Address - Country:US
Practice Address - Phone:314-226-3308
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-10
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY 60340649103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist