Active NPI
John Kidwell, PSYD
- Mental Health Counselor
- Bethlehem, PA
National Provider Identifier
1194182071
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- Practice address
- 19 E Elizabeth Ave
Bethlehem, PA 18018-6520 - Phone
- (610) 865-1699
- Fax
- (610) 419-3446
- NPI assigned
- Jan 22, 2016
- Last updated
- Jan 22, 2016
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | PA | Primary |
Addresses
Primary practice location
19 E Elizabeth Ave
Bethlehem, PA 18018-6520
Mailing address
19 E Elizabeth Ave
Bethlehem, PA 18018-6520
Phone (610) 865-1699
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 542083365 | Medicaid | PA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1453420800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1453420800000",
"number": "1194182071",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "19 E ELIZABETH AVE",
"city": "BETHLEHEM",
"state": "PA",
"postal_code": "180186520",
"telephone_number": "610-865-1699",
"fax_number": "610-419-3446"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "19 E ELIZABETH AVE",
"city": "BETHLEHEM",
"state": "PA",
"postal_code": "180186520",
"telephone_number": "610-865-1699",
"fax_number": "610-419-3446"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIDWELL",
"first_name": "JOHN",
"credential": "PSYD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-01-22",
"last_updated": "2016-01-22",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "PA",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "542083365",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bethlehem, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.