Provider Demographics
NPI:1780778605
Name:KASOWSKI, ELAINE M (PHD)
Entity type:Individual
Prefix:DR
First Name:ELAINE
Middle Name:M
Last Name:KASOWSKI
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 1:6 DICKINSON DRIVE
Mailing Address - Street 2:SUITE 216
Mailing Address - City:CHADDS FORD
Mailing Address - State:PA
Mailing Address - Zip Code:19317-9689
Mailing Address - Country:US
Mailing Address - Phone:610-358-3355
Mailing Address - Fax:
Practice Address - Street 1:6 DICKINSON DRIVE
Practice Address - Street 2:SUITE 216
Practice Address - City:CHADDS FORD
Practice Address - State:PA
Practice Address - Zip Code:19317-9689
Practice Address - Country:US
Practice Address - Phone:610-358-3355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS002721L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0033286000OtherBLUE SHIELD
R05273Medicare ID - Type Unspecified
PA0033286000OtherBLUE SHIELD