=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407737984
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KATHRYN TRABALKA LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/10/2025
-----------------------------------------------------
Last Update Date | 09/10/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 649 N LEWIS RD STE 100-2
-----------------------------------------------------
City | ROYERSFORD
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19468-1234
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-951-2197
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6 PONDS EDGE DR STE 1
-----------------------------------------------------
City | CHADDS FORD
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19317-7352
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-951-2197
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | CW026274
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------