Kenneth Harold Vaughan, PSYD
Individual provider Active NPI Psychologist · Allentown, NJ
NPI 1609953447 · NPPES record last updated Jul 5, 2019
Key facts
- NPI
- 1609953447
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychologist 103T00000X
- License
- 35SI00380100 (NJ)
- Practice address
- 3 South Main Street
Suite #6
Allentown, NJ 08501 - Phone
- (609) 259-6200
- Fax
- (609) 259-6288
- NPI assigned
- Nov 1, 2006
- Sex
- Male
- Sole proprietor
- Yes
Medicare Care Compare profile
- Specialty
- Clinical Psychologist
- Education
- Other, 1995
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
3 S Main St
Suite 6
Allentown, NJ 08501-1683
Phone (609) 259-6200
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NJ
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20041105000015 | NJ | Practitioner - Clinical Psychologist | 5698738235 | Practice locations: Allentown, NJ |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 35SI00380100 | NJ | MD | Psychologist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 35SI00380100 | NJ | Yes |
Addresses
Primary practice location
3 South Main Street
Suite #6
Allentown, NJ 08501
Mailing address
11 Tin House Road
Medford, NJ 08055-9735
Phone (609) 259-6200
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 232446000 | Other | MAGELLAN | |
| 342277 | Other | TRICARE |
Other providers in Allentown, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 5, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.