Provider Demographics
NPI:1891124012
Name:WEST, PEPUKAYI (LDT-C)
Entity Type:Individual
Prefix:
First Name:PEPUKAYI
Middle Name:
Last Name:WEST
Suffix:
Gender:F
Credentials:LDT-C
Other - Prefix:
Other - First Name:PEPUKAYI
Other - Middle Name:DAMAIL
Other - Last Name:JACKSON-LEVINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:164 CLINTON PL APT 1E
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-4653
Mailing Address - Country:US
Mailing Address - Phone:201-952-6631
Mailing Address - Fax:
Practice Address - Street 1:455 COLONIAL TER
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-1403
Practice Address - Country:US
Practice Address - Phone:201-996-9264
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-07
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ235716103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst