Provider Demographics
NPI:1144356163
Name:WEST, KATHLEEN JOYCE (PHD)
Entity type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:JOYCE
Last Name:WEST
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 BRANDYWINE AVE
Mailing Address - Street 2:
Mailing Address - City:DOWNINGTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19335-3418
Mailing Address - Country:US
Mailing Address - Phone:484-883-1040
Mailing Address - Fax:267-494-0355
Practice Address - Street 1:530 BRANDYWINE AVE
Practice Address - Street 2:
Practice Address - City:DOWNINGTOWN
Practice Address - State:PA
Practice Address - Zip Code:19335-3418
Practice Address - Country:US
Practice Address - Phone:610-518-6020
Practice Address - Fax:267-494-0355
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS008361L103T00000X
PAPS-008361-L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0016174800003Medicare ID - Type UnspecifiedPROMISE