Provider Demographics
NPI:1700843737
Name:PETULLA, KATHLEEN L (LCSW)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:L
Last Name:PETULLA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1012 CIDER MILL DR
Mailing Address - Street 2:
Mailing Address - City:GIBSONIA
Mailing Address - State:PA
Mailing Address - Zip Code:15044-9284
Mailing Address - Country:US
Mailing Address - Phone:412-889-2333
Mailing Address - Fax:
Practice Address - Street 1:5000 MCKNIGHT RD STE 202
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15237-3420
Practice Address - Country:US
Practice Address - Phone:412-366-8342
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0147221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1434077OtherHIGHMARK
PA493578000OtherMAGELLAN
PA081809FT5Medicare ID - Type UnspecifiedMEDICARE