Provider Demographics
NPI:1104034685
Name:KOLKO, DAVID J (PHD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:J
Last Name:KOLKO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3811 O'HARA ST.
Mailing Address - Street 2:RM. 541 ,WPIC,
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15213-2593
Mailing Address - Country:US
Mailing Address - Phone:412-246-5888
Mailing Address - Fax:412-246-5341
Practice Address - Street 1:3811 OHARA ST
Practice Address - Street 2:RM. 541
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15213-2593
Practice Address - Country:US
Practice Address - Phone:412-246-5888
Practice Address - Fax:412-246-5341
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS004691L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical