Provider Demographics
NPI:1932487550
Name:TOLLEFSON, KIRSTEN ELIZABETH (MD)
Entity Type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:ELIZABETH
Last Name:TOLLEFSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4641 ROOSEVELT BLVD
Mailing Address - Street 2:FRIENDS' HOSPITAL,DUCOM ADULT PSYCHIATRY RESIDENCY OFFC
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19124-2343
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4641 ROOSEVELT BLVD
Practice Address - Street 2:FRIENDS' HOSPITAL,DUCOM ADULT PSYCHIATRY RESIDENCY OFFC
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19124-2343
Practice Address - Country:US
Practice Address - Phone:267-507-6581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-31
Last Update Date:2011-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT1957682084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry