Provider Demographics
NPI:1942925177
Name:KEGARISE, KATHERINE CLARK
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:CLARK
Last Name:KEGARISE
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 1:540 CELERON ST
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15221-3203
Mailing Address - Country:US
Mailing Address - Phone:412-512-4334
Mailing Address - Fax:
Practice Address - Street 1:1200 REEDSDALE ST
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15233-2109
Practice Address - Country:US
Practice Address - Phone:412-323-8026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-10
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC014975101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional