Provider Demographics
NPI:1225330327
Name:KOSAREK, DEANNA KATHLEEN (LPC)
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:KATHLEEN
Last Name:KOSAREK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12872 RAYMOND DR
Mailing Address - Street 2:APT 1A
Mailing Address - City:MEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16335-8418
Mailing Address - Country:US
Mailing Address - Phone:814-333-9383
Mailing Address - Fax:
Practice Address - Street 1:11488 STATE HIGHWAY 98
Practice Address - Street 2:
Practice Address - City:MEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:16335
Practice Address - Country:US
Practice Address - Phone:814-337-2224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-22
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC005680101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health