Provider Demographics
NPI:1760215735
Name:VALA, KATELYN (PSYD)
Entity type:Individual
Prefix:
First Name:KATELYN
Middle Name:
Last Name:VALA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 PRINCETON CT
Mailing Address - Street 2:
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19047-1644
Mailing Address - Country:US
Mailing Address - Phone:267-987-8468
Mailing Address - Fax:
Practice Address - Street 1:123 CHESTNUT ST STE 304
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19106-3059
Practice Address - Country:US
Practice Address - Phone:215-399-4128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-23
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS020248103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist