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: 10/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 LONGVIEW DR
TORRANCE PA
15779
US

IV. Provider business mailing address

336 BLOOMFIELD ST STE 203
JOHNSTOWN PA
15904-3271
US

V. Phone/Fax

Practice location:
  • Phone: 724-675-2106
  • Fax:
Mailing address:
  • Phone: 814-266-3196
  • 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: