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General NPI Number Information
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NPI Number | 1285404640
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Entity Type | Individual
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Provider Name | TRACEY LATIMORE KENWORTHY PHD
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Gender | Female
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Dates
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Enumeration Date | 01/08/2024
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Last Update Date | 04/08/2024
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Provider Practice Location Address
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Address Line | 160 COWAN RD
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City | PARKESBURG
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State | PA
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Zip | 19365-2109
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Country | US
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Telephone | 302-428-9487
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Fax |
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Provider Business Mailing Address
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Address Line | 108 TYLER DR.
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City | COATESVILLE
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State | PA
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Zip | 19320-2109
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Country | US
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Telephone | 302-615-1996
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Fax | 484-786-4796
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PS019219
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License Number State | PA
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