Provider Demographics
NPI:1063068294
Name:THIGPEN, KAI Z (LSW)
Entity type:Individual
Prefix:
First Name:KAI
Middle Name:Z
Last Name:THIGPEN
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:CAMILLE
Other - Middle Name:ZOE
Other - Last Name:THIGPEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:126 ARGYLE RD APT B6
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:PA
Mailing Address - Zip Code:19003-2830
Mailing Address - Country:US
Mailing Address - Phone:215-696-0614
Mailing Address - Fax:
Practice Address - Street 1:1348 BAINBRIDGE ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19147-1810
Practice Address - Country:US
Practice Address - Phone:215-563-0652
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-13
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW135490104100000X
PACW0217531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker