Healthcare Provider Details

I. General information

NPI: 1063068294
Provider Name (Legal Business Name): KAI Z. THIGPEN LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CAMILLE ZOE THIGPEN

II. Dates (important events)

Enumeration Date: 08/13/2019
Last Update Date: 04/12/2021
Certification Date: 04/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1348 BAINBRIDGE ST
PHILADELPHIA PA
19147-1810
US

IV. Provider business mailing address

126 ARGYLE RD APT B6
ARDMORE PA
19003-2830
US

V. Phone/Fax

Practice location:
  • Phone: 215-563-0652
  • Fax:
Mailing address:
  • Phone: 215-696-0614
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW135490
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW021753
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: