Provider Demographics
NPI:1144778333
Name:BASCOM, KATHERINE (MS, LBS)
Entity Type:Individual
Prefix:MISS
First Name:KATHERINE
Middle Name:
Last Name:BASCOM
Suffix:
Gender:F
Credentials:MS, LBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 NESHAMINY INTERPLEX DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:TREVOSE
Mailing Address - State:PA
Mailing Address - Zip Code:19053-6944
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4 NESHAMINY INTERPLEX DR
Practice Address - Street 2:SUITE 202
Practice Address - City:TREVOSE
Practice Address - State:PA
Practice Address - Zip Code:19053-6944
Practice Address - Country:US
Practice Address - Phone:215-322-8860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-15
Last Update Date:2016-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst