Provider Demographics
NPI:1154589893
Name:WILLIAMSPORT PSYCHOLOGICAL ASSOCIATES
Entity type:Organization
Organization Name:WILLIAMSPORT PSYCHOLOGICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:W
Authorized Official - Last Name:KELSEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:570-322-2603
Mailing Address - Street 1:811 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17701-3402
Mailing Address - Country:US
Mailing Address - Phone:570-322-2603
Mailing Address - Fax:570-322-4208
Practice Address - Street 1:811 MARKET ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-3402
Practice Address - Country:US
Practice Address - Phone:570-322-2603
Practice Address - Fax:570-322-4208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-29
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty