Healthcare Provider Details

I. General information

NPI: 1184059065
Provider Name (Legal Business Name): KATHLEEN DZURA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2013
Last Update Date: 07/07/2025
Certification Date: 07/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 ARABIAN LN
WASHINGTON PA
15301-0905
US

IV. Provider business mailing address

PO BOX 155
MEADOW LANDS PA
15347-0155
US

V. Phone/Fax

Practice location:
  • Phone: 724-263-6635
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW018089
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: