Provider Demographics
NPI:1770684888
Name:PARKERTON, KATHRYN K (PSYD)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:K
Last Name:PARKERTON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:162 HUNTER AVE
Mailing Address - Street 2:
Mailing Address - City:FANWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07023-1031
Mailing Address - Country:US
Mailing Address - Phone:908-322-8948
Mailing Address - Fax:
Practice Address - Street 1:162 HUNTER AVE
Practice Address - Street 2:
Practice Address - City:FANWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07023-1031
Practice Address - Country:US
Practice Address - Phone:908-322-8948
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNJLIC35S100256100103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist