Provider Demographics
NPI:1912735457
Name:KERN, ELWYN (LPC)
Entity type:Individual
Prefix:
First Name:ELWYN
Middle Name:
Last Name:KERN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2429 AVONDALE AVE
Mailing Address - Street 2:
Mailing Address - City:ROSLYN
Mailing Address - State:PA
Mailing Address - Zip Code:19001-4202
Mailing Address - Country:US
Mailing Address - Phone:215-983-7887
Mailing Address - Fax:
Practice Address - Street 1:2429 AVONDALE AVE
Practice Address - Street 2:
Practice Address - City:ROSLYN
Practice Address - State:PA
Practice Address - Zip Code:19001-4202
Practice Address - Country:US
Practice Address - Phone:215-983-7887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-25
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC014270101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health