Provider Demographics
NPI:1649216060
Name:LANDIS, KATHRYN ANNE (MSW LSW)
Entity Type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:ANNE
Last Name:LANDIS
Suffix:
Gender:F
Credentials:MSW LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 N SHIPPEN STREET
Mailing Address - Street 2:UNIT 421
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17602
Mailing Address - Country:US
Mailing Address - Phone:717-293-0378
Mailing Address - Fax:717-293-0887
Practice Address - Street 1:2819-0 WILLOW STREET PIKE
Practice Address - Street 2:LIFE SPAN PSYCHOLOGICAL SERVICES, PC
Practice Address - City:WILLOW STREET
Practice Address - State:PA
Practice Address - Zip Code:17584
Practice Address - Country:US
Practice Address - Phone:717-464-1464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW-011339-L1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA166269OtherVALUE OPTIONS
PA50006711OtherCAP BLUE CROSS
PA01878351Medicare ID - Type Unspecified