Provider Demographics
NPI:1306955505
Name:LINCOLN, SEAN KATHLEEN (PHD)
Entity type:Individual
Prefix:DR
First Name:SEAN
Middle Name:KATHLEEN
Last Name:LINCOLN
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 1:3901 CITY AVE
Mailing Address - Street 2:A1222
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19131-2909
Mailing Address - Country:US
Mailing Address - Phone:215-868-8425
Mailing Address - Fax:
Practice Address - Street 1:105 BALA AVE
Practice Address - Street 2:
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-3307
Practice Address - Country:US
Practice Address - Phone:215-868-8425
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS008846L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist