Provider Demographics
NPI:1376632901
Name:KASMEN, LORI J (PSYD)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:J
Last Name:KASMEN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 BALA AVE
Mailing Address - Street 2:
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-3025
Mailing Address - Country:US
Mailing Address - Phone:610-667-6490
Mailing Address - Fax:610-667-1744
Practice Address - Street 1:112 BALA AVE
Practice Address - Street 2:
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-3025
Practice Address - Country:US
Practice Address - Phone:610-667-6490
Practice Address - Fax:610-667-1744
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS015233103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2134279000OtherINDEPENDENCE BLUE CROSS
PA1451540OtherBLUE SHIELD
PA070963Medicare ID - Type Unspecified