Provider Demographics
NPI:1053481358
Name:ZAKARIAN, KATHY W (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KATHY
Middle Name:W
Last Name:ZAKARIAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:KATHY
Other - Middle Name:S
Other - Last Name:WURSTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:1521 WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17701-5426
Mailing Address - Country:US
Mailing Address - Phone:570-322-5051
Mailing Address - Fax:570-322-6788
Practice Address - Street 1:1521 WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-5426
Practice Address - Country:US
Practice Address - Phone:570-322-5051
Practice Address - Fax:570-322-6788
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS015696103TC0700X
103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1928168OtherHIGHMARK BLUE SHIELD
107509VBCMedicare PIN