Provider Demographics
NPI:1790510725
Name:CHUN-KENNEDY, CAITLIN (PHD)
Entity type:Individual
Prefix:
First Name:CAITLIN
Middle Name:
Last Name:CHUN-KENNEDY
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 1:2007 PARK FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16803-1333
Mailing Address - Country:US
Mailing Address - Phone:717-321-3675
Mailing Address - Fax:
Practice Address - Street 1:2007 PARK FOREST AVE
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16803-1333
Practice Address - Country:US
Practice Address - Phone:717-321-3675
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-09
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS019157103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling