Provider Demographics
NPI:1649587015
Name:CHILDS, VERONICA
Entity Type:Individual
Prefix:
First Name:VERONICA
Middle Name:
Last Name:CHILDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1870 LARKIN RD
Mailing Address - Street 2:
Mailing Address - City:UPPER CHICHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19061-2307
Mailing Address - Country:US
Mailing Address - Phone:610-485-3434
Mailing Address - Fax:
Practice Address - Street 1:305 VALLEYBROOK RD
Practice Address - Street 2:
Practice Address - City:CHESTER HEIGHTS
Practice Address - State:PA
Practice Address - Zip Code:19017-0534
Practice Address - Country:US
Practice Address - Phone:610-358-2250
Practice Address - Fax:610-358-2251
Is Sole Proprietor?:No
Enumeration Date:2010-09-08
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC005574101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional