Provider Demographics
NPI:1013400324
Name:LENNON, KATIE
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:LENNON
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 1:1325 GRANGER RD
Mailing Address - Street 2:
Mailing Address - City:NORTHAMPTON
Mailing Address - State:PA
Mailing Address - Zip Code:18067-9132
Mailing Address - Country:US
Mailing Address - Phone:610-730-1757
Mailing Address - Fax:
Practice Address - Street 1:520 E BROAD ST STE 2
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18018-6330
Practice Address - Country:US
Practice Address - Phone:610-973-5335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-11
Last Update Date:2018-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0195831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical