1578994992 NPI number — AMANDA ELAINE KOCHAN-DEWEY PSY.D.

Table of content: AMANDA ELAINE KOCHAN-DEWEY PSY.D. (NPI 1578994992)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578994992 NPI number — AMANDA ELAINE KOCHAN-DEWEY PSY.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KOCHAN-DEWEY
Provider First Name:
AMANDA
Provider Middle Name:
ELAINE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PSY.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SMITH
Provider Other First Name:
AMANDA
Provider Other Middle Name:
KOCHAN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PSYD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1578994992
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/30/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1255 S. CEDAR CREST BLVD
Provider Second Line Business Mailing Address:
SUITE 1200
Provider Business Mailing Address City Name:
ALLENTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18103
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-437-4800
Provider Business Mailing Address Fax Number:
484-725-6437

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1255 S. CEDAR CREST BLVD
Provider Second Line Business Practice Location Address:
SUITE 1200
Provider Business Practice Location Address City Name:
ALLENTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-437-4800
Provider Business Practice Location Address Fax Number:
484-725-6437
Provider Enumeration Date:
12/11/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  PS017838 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)