Provider Demographics
NPI:1689481533
Name:VAUGHN, SYDNEY
Entity type:Individual
Prefix:MISS
First Name:SYDNEY
Middle Name:
Last Name:VAUGHN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 S LYNWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:GLENSIDE
Mailing Address - State:PA
Mailing Address - Zip Code:19038-3404
Mailing Address - Country:US
Mailing Address - Phone:215-740-6919
Mailing Address - Fax:
Practice Address - Street 1:25 WASHINGTON LN STE 3A
Practice Address - Street 2:
Practice Address - City:WYNCOTE
Practice Address - State:PA
Practice Address - Zip Code:19095-1425
Practice Address - Country:US
Practice Address - Phone:267-810-7589
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-13
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health