Provider Demographics
NPI:1801965629
Name:KINNEY, PHILIP J (PHD)
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:J
Last Name:KINNEY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2233 WALBERT AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-1358
Mailing Address - Country:US
Mailing Address - Phone:610-435-8480
Mailing Address - Fax:
Practice Address - Street 1:2233 WALBERT AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-1358
Practice Address - Country:US
Practice Address - Phone:610-435-8480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS006139L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA02876800OtherCAPITAL BLUE CROSS ID
PAKI727466OtherHIGHMARK BLUE SHIELD ID