Healthcare Provider Details

I. General information

NPI: 1477795177
Provider Name (Legal Business Name): KATHERINE MICHOS PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2009
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 S 4TH ST STE 471
PHILADELPHIA PA
19147-1582
US

IV. Provider business mailing address

525 S 4TH ST STE 471
PHILADELPHIA PA
19147-1582
US

V. Phone/Fax

Practice location:
  • Phone: 267-861-3685
  • Fax: 215-965-1513
Mailing address:
  • Phone: 267-861-3685
  • Fax: 215-965-1513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number35SI00530700
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS016592
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: