Provider Demographics
NPI:1669903779
Name:PROTOS, KATHERINE ELEANOR (LCSW)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ELEANOR
Last Name:PROTOS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KAYTI
Other - Middle Name:
Other - Last Name:PROTOS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:444 S STATE ST STE B3
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18940-1945
Mailing Address - Country:US
Mailing Address - Phone:267-563-8738
Mailing Address - Fax:
Practice Address - Street 1:444 S STATE ST STE B3
Practice Address - Street 2:
Practice Address - City:NEWTOWN
Practice Address - State:PA
Practice Address - Zip Code:18940-1945
Practice Address - Country:US
Practice Address - Phone:267-563-8738
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-22
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0192461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical