Healthcare Provider Details

I. General information

NPI: 1871974824
Provider Name (Legal Business Name): MARY RUTH KUCERA LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2015
Last Update Date: 06/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 JUNIPER LN
LIGONIER PA
15658-9727
US

IV. Provider business mailing address

117 JUNIPER LN
LIGONIER PA
15658-9727
US

V. Phone/Fax

Practice location:
  • Phone: 724-238-5556
  • Fax: 724-238-9533
Mailing address:
  • Phone: 724-238-5556
  • Fax: 724-238-9533

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMF000733
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: