Lydia Brill, PSY.D.

Key facts

NPI

1326512005

Entity type

Individual (NPI type 1)

Primary specialty

Clinical Child & Adolescent Psychologist 103TC2200X

License

PS018727 (PA)

Practice address

480 Pierce St Ste 109
Kingston, PA 18704-5512

Phone

(570) 574-0907

Fax

(570) 287-5211

NPI assigned

Jan 16, 2019

Sex

Female

Sole proprietor

Yes

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

State licenses

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jan 16, 2019.

{
    "created_epoch": "1547596800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1547596800000",
    "number": "1326512005",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "237 CONSTITUTION AVE",
            "city": "HANOVER TOWNSHIP",
            "state": "PA",
            "postal_code": "187064154",
            "telephone_number": "570-574-0907"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "480 PIERCE ST STE 109",
            "city": "KINGSTON",
            "state": "PA",
            "postal_code": "187045512",
            "telephone_number": "570-574-0907",
            "fax_number": "570-287-5211"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRILL",
        "first_name": "LYDIA",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-01-16",
        "last_updated": "2019-01-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "PA",
            "license": "PS018727",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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All providers in Kingston, PA · Clinical Child & Adolescent Psychologist in Pennsylvania