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Individual

MS. COLEEN VANDERBEEK

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PSY D.

Contact information

Practice address
1247 S CEDAR CREST BLVD STE 107, ALLENTOWN, PA 18103-6347
(484) 200-5208
Mailing address
1247 S CEDAR CREST BLVD STE 107, ALLENTOWN, PA 18103-6347
(484) 200-5208

Taxonomy

Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
37PC00881500
NJ
103TC1900X
Counseling Psychologist
PERMIT TP#083-911
NJ

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0023701
AGENCY MEDICAID PROVIDER NUMBER
NJ
01
527486
AGENCY MEDICARE PROVIDER NUMBER
NJ
Enumeration date
07/07/2008
Last updated
05/20/2023
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