Provider Demographics
NPI:1285837898
Name:PODLISKA, KATHERINE CONE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:CONE
Last Name:PODLISKA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:MARIE
Other - Last Name:CONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:CMR 480, BOX 997
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09128
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:GEB 2996 PANZER KASERNE
Practice Address - Street 2:
Practice Address - City:BOEBLINGEN
Practice Address - State:GERMANY
Practice Address - Zip Code:71032
Practice Address - Country:DE
Practice Address - Phone:0703-115-2676
Practice Address - Fax:0703-115-2967
Is Sole Proprietor?:No
Enumeration Date:2007-06-10
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX409361041C0700X
MD122961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD000Medicare UPIN