Provider Demographics
NPI:1982158390
Name:KINGFIELD, ELIZABETH MADELEINE ORTON (MA)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:MADELEINE ORTON
Last Name:KINGFIELD
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MS
Other - First Name:ELIZABETH
Other - Middle Name:MADELEINE ORTON
Other - Last Name:FIELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1221 LOCUST ST FL 2
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-5570
Mailing Address - Country:US
Mailing Address - Phone:484-224-5520
Mailing Address - Fax:
Practice Address - Street 1:1221 LOCUST ST FL 2
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-5570
Practice Address - Country:US
Practice Address - Phone:484-224-5520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-15
Last Update Date:2019-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
PAPS018927103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program