Provider Demographics
NPI:1497380273
Name:PARK, CATHERINE LEE (MS, BSL)
Entity Type:Individual
Prefix:MRS
First Name:CATHERINE
Middle Name:LEE
Last Name:PARK
Suffix:
Gender:F
Credentials:MS, BSL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:993 ROUNDHOUSE CT
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19380-1789
Mailing Address - Country:US
Mailing Address - Phone:215-796-0695
Mailing Address - Fax:
Practice Address - Street 1:993 ROUNDHOUSE CT
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380-1789
Practice Address - Country:US
Practice Address - Phone:215-796-0695
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-11
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH001761103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst