Provider Demographics
NPI:1023177276
Name:KIRKPATRICK, MARY JANE (PHD)
Entity type:Individual
Prefix:MS
First Name:MARY JANE
Middle Name:
Last Name:KIRKPATRICK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1012 NEW GALENA RD
Mailing Address - Street 2:
Mailing Address - City:DOYLESTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18901-5524
Mailing Address - Country:US
Mailing Address - Phone:215-249-3909
Mailing Address - Fax:215-249-3909
Practice Address - Street 1:1012 NEW GALENA RD
Practice Address - Street 2:
Practice Address - City:DOYLESTOWN
Practice Address - State:PA
Practice Address - Zip Code:18901-5524
Practice Address - Country:US
Practice Address - Phone:215-249-3909
Practice Address - Fax:215-249-3909
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS003133L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAKI1544366OtherHIGHMARK BLUESHIELD #