Provider Demographics
NPI:1033516786
Name:SMITH, KATHLEEN (LSW)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94 PARK VALLEI LN
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:PA
Mailing Address - Zip Code:19015-3323
Mailing Address - Country:US
Mailing Address - Phone:610-836-1450
Mailing Address - Fax:484-445-4149
Practice Address - Street 1:100 W SIXTH ST
Practice Address - Street 2:SUITE 305
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-2428
Practice Address - Country:US
Practice Address - Phone:484-445-4147
Practice Address - Fax:484-445-4149
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-24
Last Update Date:2016-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW130561104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker