Provider Demographics
NPI:1437256856
Name:TATROW, KRISTIN J (PHD)
Entity type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:J
Last Name:TATROW
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:PO BOX 104
Mailing Address - Street 2:
Mailing Address - City:FOUNTAINVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18923-0104
Mailing Address - Country:US
Mailing Address - Phone:215-257-1633
Mailing Address - Fax:267-867-7526
Practice Address - Street 1:5055 SWAMP RD STE 202
Practice Address - Street 2:
Practice Address - City:FOUNTAINVILLE
Practice Address - State:PA
Practice Address - Zip Code:18923-9655
Practice Address - Country:US
Practice Address - Phone:215-257-1633
Practice Address - Fax:267-867-7526
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015738103TC0700X
PAPS015768103TC0700X
FLPY11803103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAQ58431Medicare UPIN
PA096557NB0Medicare PIN