Provider Demographics
NPI:1588627525
Name:MINER, CATHLEEN ANNA (PHD)
Entity Type:Individual
Prefix:DR
First Name:CATHLEEN
Middle Name:ANNA
Last Name:MINER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:CATHLEEN
Other - Middle Name:ANN
Other - Last Name:ASHBAUGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:312 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16505-2326
Mailing Address - Country:US
Mailing Address - Phone:814-490-3376
Mailing Address - Fax:
Practice Address - Street 1:100 STATE ST
Practice Address - Street 2:SUITE 202
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16507-1452
Practice Address - Country:US
Practice Address - Phone:814-464-0958
Practice Address - Fax:814-459-2303
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC003465101YP2500X
PAPS015997103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1015332670001Medicaid