Provider Demographics
NPI:1558324723
Name:SMITH, KATHLEEN (PHD)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:SMITH
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 1:307 4TH AVE
Mailing Address - Street 2:BANK TOWER THIRD FLOOR
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15222-2108
Mailing Address - Country:US
Mailing Address - Phone:412-391-7552
Mailing Address - Fax:412-391-6640
Practice Address - Street 1:307 4TH AVE
Practice Address - Street 2:BANK TOWER THIRD FLOOR
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15222-2108
Practice Address - Country:US
Practice Address - Phone:412-391-7552
Practice Address - Fax:412-391-6640
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS005897L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA650336OtherPA BLUE SHIELD
PA056926OtherVALUE OPTIONS
PA2177080OtherAETNA
AL517037OtherHIGHMARK
PA000006OtherUPMC