Provider Demographics
NPI:1669635009
Name:VANDERBEEK, COLEEN (PSY D)
Entity Type:Individual
Prefix:MS
First Name:COLEEN
Middle Name:
Last Name:VANDERBEEK
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1247 S CEDAR CREST BLVD STE 107
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-6347
Mailing Address - Country:US
Mailing Address - Phone:484-200-5208
Mailing Address - Fax:
Practice Address - Street 1:1247 S CEDAR CREST BLVD STE 107
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-6347
Practice Address - Country:US
Practice Address - Phone:484-200-5208
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-07
Last Update Date:2023-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJPERMIT TP#083-911103TC1900X
NJ37PC00881500101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ527486OtherAGENCY MEDICARE PROVIDER NUMBER
NJ0023701OtherAGENCY MEDICAID PROVIDER NUMBER