Provider Demographics
NPI:1477601193
Name:KUTERBACH, LAURA DIANE (PHD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:DIANE
Last Name:KUTERBACH
Suffix:
Gender:F
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:PO BOX 459
Mailing Address - Street 2:
Mailing Address - City:MILESBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16853-0459
Mailing Address - Country:US
Mailing Address - Phone:814-355-4605
Mailing Address - Fax:
Practice Address - Street 1:1633 PHILIPSBURG BIGLER HWY
Practice Address - Street 2:CEN-CLEAR CHILD SERVICES, INC.
Practice Address - City:PHILIPSBURG
Practice Address - State:PA
Practice Address - Zip Code:16866-8112
Practice Address - Country:US
Practice Address - Phone:814-342-5845
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS015463103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAKU1916356OtherHIGHMARK PROVIDER NUMBER