Provider Demographics
NPI:1750110250
Name:ZEBERTAVAGE, KATHERINE HERMINIA (MSW, LSW)
Entity type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:HERMINIA
Last Name:ZEBERTAVAGE
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:MISS
Other - First Name:KATHERINE
Other - Middle Name:HERMINIA
Other - Last Name:ADDISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 513
Mailing Address - Street 2:
Mailing Address - City:LEESPORT
Mailing Address - State:PA
Mailing Address - Zip Code:19533-0513
Mailing Address - Country:US
Mailing Address - Phone:610-750-0223
Mailing Address - Fax:
Practice Address - Street 1:20 MAIN ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:PA
Practice Address - Zip Code:17517-1610
Practice Address - Country:US
Practice Address - Phone:610-750-0223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-31
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW141833101YM0800X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health