Provider Demographics
NPI:1871821959
Name:VAN DOREN, KRISTIN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:
Last Name:VAN DOREN
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 1:2000 VALLEY FORGE CIR STE 103
Mailing Address - Street 2:
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-4538
Mailing Address - Country:US
Mailing Address - Phone:610-878-9330
Mailing Address - Fax:610-878-9331
Practice Address - Street 1:2000 VALLEY FORGE CIR STE 103
Practice Address - Street 2:
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406-4538
Practice Address - Country:US
Practice Address - Phone:610-878-9330
Practice Address - Fax:610-878-9331
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-30
Last Update Date:2019-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS016748103TC0700X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical