Provider Demographics
NPI:1568765279
Name:FUSSELBAUGH, KATHARINE A
Entity Type:Individual
Prefix:
First Name:KATHARINE
Middle Name:A
Last Name:FUSSELBAUGH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 HYETTS CORNER RD
Mailing Address - Street 2:ATTEN: G HOWARD
Mailing Address - City:MIDDLETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19709-8907
Mailing Address - Country:US
Mailing Address - Phone:302-449-3603
Mailing Address - Fax:302-376-6796
Practice Address - Street 1:318 E BASIN RD
Practice Address - Street 2:COLONIAL SCHOOL DIST
Practice Address - City:NEW CASTLE
Practice Address - State:DE
Practice Address - Zip Code:19720-4214
Practice Address - Country:US
Practice Address - Phone:302-323-2700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-20
Last Update Date:2010-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE55538103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool