Provider Demographics
NPI:1689923419
Name:GASTGEB, HOLLY ZAJAC (PHD)
Entity Type:Individual
Prefix:DR
First Name:HOLLY
Middle Name:ZAJAC
Last Name:GASTGEB
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 1:1150 THORN RUN RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:MOON TWP
Mailing Address - State:PA
Mailing Address - Zip Code:15108-3102
Mailing Address - Country:US
Mailing Address - Phone:412-329-7778
Mailing Address - Fax:412-262-1555
Practice Address - Street 1:1150 THORN RUN RD
Practice Address - Street 2:SUITE 110
Practice Address - City:MOON TWP
Practice Address - State:PA
Practice Address - Zip Code:15108-3102
Practice Address - Country:US
Practice Address - Phone:412-329-7778
Practice Address - Fax:412-262-1555
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-07
Last Update Date:2012-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS017247103T00000X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent