Active NPI
Kristen Elizabeth Smith-Simon, PH.D.
- Clinical Psychologist
- State College, PA
National Provider Identifier
1730409079
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PS016744
- Practice address
- 454 Rolling Ridge Dr
State College, PA 16801-7696 - Phone
- (814) 235-1100
- Fax
- (814) 235-1101
- NPI assigned
- Jun 9, 2010
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PS016744 | PA | Primary |
Addresses
Primary practice location
454 Rolling Ridge Dr
State College, PA 16801-7696
Mailing address
337 Moore Building
University Park, PA 16802
Phone (814) 865-2191
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)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PS016744 | PA | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Midstep Centers for Child Development, PC | Psychologist | Past | Accepting new patients |
| Julie a. Pelletier, P.C. | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Clinical Child & Adolescent Psychologist
- State College, PA
- NPI 1932578911
-
- Psychologist
- State College, PA
- NPI 1427265164
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1276041600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1621382400000",
"number": "1730409079",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "337 MOORE BUILDING",
"city": "UNIVERSITY PARK",
"state": "PA",
"postal_code": "16802",
"telephone_number": "814-865-2191",
"fax_number": "814-863-1331"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "454 ROLLING RIDGE DR",
"city": "STATE COLLEGE",
"state": "PA",
"postal_code": "168017696",
"telephone_number": "814-235-1100",
"fax_number": "814-235-1101"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SMITH-SIMON",
"first_name": "KRISTEN",
"middle_name": "ELIZABETH",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-06-09",
"last_updated": "2021-05-19",
"certification_date": "2021-04-30",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "PA",
"license": "PS016744",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in State College, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.