Provider Demographics
NPI:1902819378
Name:MCCORKLE, KATHARINE CALDWELL (PHD)
Entity Type:Individual
Prefix:DR
First Name:KATHARINE
Middle Name:CALDWELL
Last Name:MCCORKLE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:KATHARINE
Other - Middle Name:CALDWELL
Other - Last Name:MCCORKLE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:12703B PERRY HWY
Mailing Address - Street 2:
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-8441
Mailing Address - Country:US
Mailing Address - Phone:724-719-2991
Mailing Address - Fax:
Practice Address - Street 1:12703B PERRY HWY
Practice Address - Street 2:
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-8441
Practice Address - Country:US
Practice Address - Phone:724-719-2991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2014-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS006802L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01814078Medicaid
PA01814078Medicaid
PA746461Medicare ID - Type Unspecified