Provider Demographics
NPI:1457852568
Name:LEHIGH VALLEY CHILD PSYCHOLOGY CENTER LLC
Entity Type:Organization
Organization Name:LEHIGH VALLEY CHILD PSYCHOLOGY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:STACY
Authorized Official - Middle Name:DURNAN
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:484-935-3434
Mailing Address - Street 1:4890 MAJESTIC DR
Mailing Address - Street 2:
Mailing Address - City:COOPERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18036-8722
Mailing Address - Country:US
Mailing Address - Phone:610-295-7834
Mailing Address - Fax:
Practice Address - Street 1:6666 PASSER RD STE 2
Practice Address - Street 2:
Practice Address - City:COOPERSBURG
Practice Address - State:PA
Practice Address - Zip Code:18036-1258
Practice Address - Country:US
Practice Address - Phone:484-935-3434
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-23
Last Update Date:2018-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health