Provider Demographics
NPI:1366635567
Name:GRENTZENBERG, KATHRYN CORRELL (LPC)
Entity Type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:CORRELL
Last Name:GRENTZENBERG
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 1:654 WOODCREST AVE
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:PA
Mailing Address - Zip Code:19003-1932
Mailing Address - Country:US
Mailing Address - Phone:610-639-7493
Mailing Address - Fax:
Practice Address - Street 1:36 E FRONT ST
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-2936
Practice Address - Country:US
Practice Address - Phone:610-639-7493
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-21
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC003938101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional