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General NPI Number Information
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NPI Number | 1508914664
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Entity Type | Individual
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Provider Name | KATHARINE BERTOLET PSY.D.
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Gender | Female
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Dates
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Enumeration Date | 01/08/2007
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 7600 STENTON AVE SUITE ONE-I
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City | PHILADELPHIA
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State | PA
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Zip | 19118-3231
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Country | US
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Telephone | 215-247-5440
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Fax | 215-887-0719
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Provider Business Mailing Address
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Address Line | PO BOX 27071
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City | PHILADELPHIA
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State | PA
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Zip | 19118-0071
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Country | US
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Telephone | 215-247-5440
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Fax | 215-887-0719
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PS-005871-L
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License Number State | PA
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