Provider Demographics
NPI:1154701639
Name:DEBOER KREIDER, ELIZABETH RACHEL (PHD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:RACHEL
Last Name:DEBOER KREIDER
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 1:15 E. WALNUT ST.
Mailing Address - Street 2:
Mailing Address - City:NAZARETH
Mailing Address - State:PA
Mailing Address - Zip Code:18064-2708
Mailing Address - Country:US
Mailing Address - Phone:610-365-5042
Mailing Address - Fax:610-365-5044
Practice Address - Street 1:15 E. WALNUT ST.
Practice Address - Street 2:
Practice Address - City:NAZARETH
Practice Address - State:PA
Practice Address - Zip Code:18064-2708
Practice Address - Country:US
Practice Address - Phone:610-365-5042
Practice Address - Fax:610-365-5044
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-01
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS017673103T00000X, 103TP2701X, 103TC0700X
NY021369103TC0700X, 103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy