Provider Demographics
NPI:1760195960
Name:POKRIVSAK, KIRA MARIE
Entity Type:Individual
Prefix:
First Name:KIRA
Middle Name:MARIE
Last Name:POKRIVSAK
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 1:80 SCHOENECK AVE
Mailing Address - Street 2:
Mailing Address - City:NAZARETH
Mailing Address - State:PA
Mailing Address - Zip Code:18064-1216
Mailing Address - Country:US
Mailing Address - Phone:484-866-3838
Mailing Address - Fax:
Practice Address - Street 1:16 S BROADWAY STE 2
Practice Address - Street 2:
Practice Address - City:WIND GAP
Practice Address - State:PA
Practice Address - Zip Code:18091-1431
Practice Address - Country:US
Practice Address - Phone:610-863-5035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-03
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC015066101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional