Provider Demographics
NPI:1275676447
Name:MACFARLANE, KATHLEEN H (PHD)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:H
Last Name:MACFARLANE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MS
Other - First Name:KATHLEEN
Other - Middle Name:H
Other - Last Name:CHARLTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:212 LAKEVIEW DRIVE
Mailing Address - Street 2:
Mailing Address - City:COLLINGSWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08108
Mailing Address - Country:US
Mailing Address - Phone:856-858-1050
Mailing Address - Fax:
Practice Address - Street 1:1600 HADDON AVENUE
Practice Address - Street 2:OUR LADY OF LOURDES HOSPITAL REGIONAL REHABILITATION
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08104
Practice Address - Country:US
Practice Address - Phone:856-757-3973
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35S100404300103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ9057005Medicaid
NJ9057005Medicaid