Healthcare Provider Details

I. General information

NPI: 1093817066
Provider Name (Legal Business Name): KATHLEEN MARIE KOCHERZAT PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 03/11/2023
Certification Date: 03/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 VIP DR
WEXFORD PA
15090-6932
US

IV. Provider business mailing address

118 RICHEY AVE
PITTSBURGH PA
15214-2037
US

V. Phone/Fax

Practice location:
  • Phone: 412-494-8448
  • Fax:
Mailing address:
  • Phone: 412-231-6370
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS007972L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: