Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TB0200X | Cognitive & Behavioral Psychologist | PS015654 | PA |
NPI | 1235146788 |
---|---|
Provider Name | Barbara Terrill Kettering |
First Address | Mountville, PA 17554-1232 |
Second Address | Lancaster, PA 17602-2137 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2006 |
Last Update Date | 02/08/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
Q40882 | (02) |