Provider Demographics
NPI:1073693214
Name:KLOSEK, CATHERINE M (MED)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:M
Last Name:KLOSEK
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 S MADISON ST
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18102-4636
Mailing Address - Country:US
Mailing Address - Phone:484-860-1529
Mailing Address - Fax:
Practice Address - Street 1:CATHERINE M. KLOSEK, M.ED.
Practice Address - Street 2:3131 COLLEGE HEIGHTS BLVD, SUITE 400
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18102
Practice Address - Country:US
Practice Address - Phone:484-860-1529
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2019-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS006331L103T00000X
103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPS006331LOtherCOMMONWEALTH OF PENNSYLVANIA
PAPS006331LOtherLICENSE