Provider Demographics
NPI:1649296559
Name:REIDY, KATHELEEN (PH D)
Entity type:Individual
Prefix:DR
First Name:KATHELEEN
Middle Name:
Last Name:REIDY
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1630 RIVERSIDE DRIVE
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08618-5837
Mailing Address - Country:US
Mailing Address - Phone:609-947-1116
Mailing Address - Fax:215-545-8496
Practice Address - Street 1:1315 WALNUT ST
Practice Address - Street 2:SUITE 1700
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-4719
Practice Address - Country:US
Practice Address - Phone:215-717-2716
Practice Address - Fax:215-545-8496
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS005184L103T00000X
NJ35SI00404500103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
7093421OtherAETNA
350265000OtherMAGELLAN BEHAVIORAL HEALT
285008OtherMHN
NJ0767179000OtherAMERIHEALTH
PA0767179000OtherAMERIHEALTH
285008OtherMHN