Provider Demographics
NPI:1508914664
Name:BERTOLET, KATHARINE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KATHARINE
Middle Name:
Last Name:BERTOLET
Suffix:
Gender:F
Credentials:PSYD
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 27071
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19118-0071
Mailing Address - Country:US
Mailing Address - Phone:215-247-5440
Mailing Address - Fax:215-887-0719
Practice Address - Street 1:7600 STENTON AVE
Practice Address - Street 2:SUITE ONE-I
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19118-3231
Practice Address - Country:US
Practice Address - Phone:215-247-5440
Practice Address - Fax:215-887-0719
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS-005871-L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA68602512Medicare UPIN
PA59686Medicare UPIN
PA650339Medicare UPIN
PA5673044Medicare UPIN
PA0481452000Medicare UPIN
PA279512Medicare UPIN