MEDICARE: DR. KATHRYN GEARHART DIES PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PY5421	FL

General Provider Information

NPI Number	:	1700834009
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KATHRYN GEARHART DIES PH.D.

Provider Business Mailing Address
First Line	:	1445 MORNING ROSE PL
Second Line	:
City	:	TRINITY
State	:	FL
Zip	:	34655-7035
Country	:	US
Telephone Number	:	727-841-0044
Fax Number	:	727-841-0043

Provider Business Practice Location Address
First Line	:	6322 ROWAN RD
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34653-3400
Country	:	US
Telephone Number	:	727-841-0044
Fax Number	:	727-841-0043

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/05/2006
Last Update Date	:	07/08/2007

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