Provider Demographics
NPI:1629284112
Name:KODMAN-JONES, CHRISTINE R (PHD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:R
Last Name:KODMAN-JONES
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 BALA AVE STE 125
Mailing Address - Street 2:
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-3217
Mailing Address - Country:US
Mailing Address - Phone:610-667-7137
Mailing Address - Fax:610-667-7141
Practice Address - Street 1:1 BALA AVE STE 125
Practice Address - Street 2:
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-3217
Practice Address - Country:US
Practice Address - Phone:610-667-7137
Practice Address - Fax:610-667-7141
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS0005287L103TC0700X, 103TC2200X, 103TF0000X
PAPS005287L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily