Provider Demographics
NPI:1356869739
Name:LEDERMANN, KATHLEEN MARY-ZELIS (PSYD)
Entity type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:MARY-ZELIS
Last Name:LEDERMANN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:353 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:NEW CUMBERLAND
Mailing Address - State:PA
Mailing Address - Zip Code:17070-1345
Mailing Address - Country:US
Mailing Address - Phone:717-576-9401
Mailing Address - Fax:
Practice Address - Street 1:120 S FILBERT ST
Practice Address - Street 2:
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17055-6593
Practice Address - Country:US
Practice Address - Phone:717-458-5788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-06
Last Update Date:2017-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS018211103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty