Provider Demographics
NPI:1376019612
Name:GORSKI, KATHRYN RAE (MMT, MT-BC, LPC)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:RAE
Last Name:GORSKI
Suffix:
Gender:F
Credentials:MMT, MT-BC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 VILLAGE DR APT 258
Mailing Address - Street 2:
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-2866
Mailing Address - Country:US
Mailing Address - Phone:540-735-4588
Mailing Address - Fax:
Practice Address - Street 1:300 VILLAGE DR APT 258
Practice Address - Street 2:
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406-2866
Practice Address - Country:US
Practice Address - Phone:540-735-4588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-14
Last Update Date:2018-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA11386225A00000X
PAPC010625101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist