Healthcare Provider Details

I. General information

NPI: 1073154480
Provider Name (Legal Business Name): KATHERINE MARY BUMBERNICK LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KATHERINE MARY BURKETT

II. Dates (important events)

Enumeration Date: 10/07/2019
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 RIDGE AVE
LATROBE PA
15650-1926
US

IV. Provider business mailing address

1110 RIDGE AVE
LATROBE PA
15650-1926
US

V. Phone/Fax

Practice location:
  • Phone: 724-220-6314
  • Fax:
Mailing address:
  • Phone: 724-220-6314
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC011679
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: