Healthcare Provider Details

I. General information

NPI: 1124578166
Provider Name (Legal Business Name): KATHERYN KUCHARSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2016
Last Update Date: 10/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136 DIAMOND ST
PHILADELPHIA PA
19122-1721
US

IV. Provider business mailing address

136 DIAMOND ST
PHILADELPHIA PA
19122-1721
US

V. Phone/Fax

Practice location:
  • Phone: 215-426-8100
  • Fax:
Mailing address:
  • Phone: 215-426-8100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW133290
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: