Provider Demographics
NPI:1609585967
Name:PIERSON, KAYMAH
Entity Type:Individual
Prefix:
First Name:KAYMAH
Middle Name:
Last Name:PIERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KEMA
Other - Middle Name:S
Other - Last Name:SISSOKO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:18 N LLANWELLYN AVE
Mailing Address - Street 2:
Mailing Address - City:GLENOLDEN
Mailing Address - State:PA
Mailing Address - Zip Code:19036-1324
Mailing Address - Country:US
Mailing Address - Phone:610-543-9530
Mailing Address - Fax:
Practice Address - Street 1:18 N LLANWELLYN AVE
Practice Address - Street 2:
Practice Address - City:GLENOLDEN
Practice Address - State:PA
Practice Address - Zip Code:19036-1324
Practice Address - Country:US
Practice Address - Phone:610-543-9530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-15
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty