Healthcare Provider Details

I. General information

NPI: 1427452424
Provider Name (Legal Business Name): KRISTEN KUTSOP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2014
Last Update Date: 10/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 COMMERCE DR
HARRISBURG PA
17110-9365
US

IV. Provider business mailing address

1308 MORRIS DR APT 201
HARRISBURG PA
17110-9162
US

V. Phone/Fax

Practice location:
  • Phone: 717-901-9906
  • Fax:
Mailing address:
  • Phone: 570-878-2677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberBH002037
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: