Provider Demographics
NPI:1730409079
Name:SMITH-SIMON, KRISTEN ELIZABETH (PHD)
Entity type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:ELIZABETH
Last Name:SMITH-SIMON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:337 MOORE BUILDING
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY PARK
Mailing Address - State:PA
Mailing Address - Zip Code:16802
Mailing Address - Country:US
Mailing Address - Phone:814-865-2191
Mailing Address - Fax:814-863-1331
Practice Address - Street 1:454 ROLLING RIDGE DR
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-7696
Practice Address - Country:US
Practice Address - Phone:814-235-1100
Practice Address - Fax:814-235-1101
Is Sole Proprietor?:No
Enumeration Date:2010-06-09
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS016744103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical