Provider Demographics
NPI:1427017110
Name:KASSEL, JANE ELLEN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JANE
Middle Name:ELLEN
Last Name:KASSEL
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 1:227 YARMOUTH LANE
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-4330
Mailing Address - Country:US
Mailing Address - Phone:610-566-2315
Mailing Address - Fax:610-566-2315
Practice Address - Street 1:2500 GRUBB ROAD
Practice Address - Street 2:SUITE 210
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19810
Practice Address - Country:US
Practice Address - Phone:610-566-2315
Practice Address - Fax:610-566-2315
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-21
Last Update Date:2009-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS005815L103TC0700X, 103T00000X
DEB1-0000409103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000017135Medicaid
DE1000032529OtherDELAWARE PHYSICIANS CARE,
PAKA652408OtherBLUESHIELD
DE1000017135Medicaid