Provider Demographics
NPI:1063782001
Name:SHIPLEY, KATHRYN M (PHD)
Entity type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:M
Last Name:SHIPLEY
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 1:444 S STATE ST BLDG A
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18940-1945
Mailing Address - Country:US
Mailing Address - Phone:267-567-3378
Mailing Address - Fax:215-550-6966
Practice Address - Street 1:444 S STATE ST BLDG A
Practice Address - Street 2:SUITE 11
Practice Address - City:NEWTOWN
Practice Address - State:PA
Practice Address - Zip Code:18940-1945
Practice Address - Country:US
Practice Address - Phone:267-567-3378
Practice Address - Fax:215-550-6966
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-07
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS017423103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical