Healthcare Provider Details

I. General information

NPI: 1053167205
Provider Name (Legal Business Name): KATELYN COCCA LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KATELYN BROWN NONE

II. Dates (important events)

Enumeration Date: 04/29/2024
Last Update Date: 04/29/2024
Certification Date: 04/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

969 GRAVEL PIKE
PALM PA
18070-1205
US

IV. Provider business mailing address

969 GRAVEL PIKE
PALM PA
18070-1205
US

V. Phone/Fax

Practice location:
  • Phone: 610-972-0430
  • Fax:
Mailing address:
  • Phone: 610-972-0430
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC017045
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: