Provider Demographics
NPI:1316832082
Name:CONGDON, KYLE EDWARD (MA, ATR-BC, LPC)
Entity type:Individual
Prefix:MR
First Name:KYLE
Middle Name:EDWARD
Last Name:CONGDON
Suffix:
Gender:M
Credentials:MA, ATR-BC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 POPLAR ST APT A
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19130-1581
Mailing Address - Country:US
Mailing Address - Phone:570-687-5122
Mailing Address - Fax:
Practice Address - Street 1:1701 POPLAR ST APT A
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19130-1581
Practice Address - Country:US
Practice Address - Phone:570-687-5122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-11
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC017941101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional