Provider Demographics
NPI:1598161986
Name:STALEY, KATHARINE (PHD)
Entity Type:Individual
Prefix:DR
First Name:KATHARINE
Middle Name:
Last Name:STALEY
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 1:1269 PENFIELD RD
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16801-6418
Mailing Address - Country:US
Mailing Address - Phone:814-360-3745
Mailing Address - Fax:
Practice Address - Street 1:1269 PENFIELD RD
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-6418
Practice Address - Country:US
Practice Address - Phone:814-360-3745
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-12
Last Update Date:2014-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS017504103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical