Provider Demographics
NPI:1124070776
Name:DEKLEVA-REBOTTINI, KAREN A (MASTERS)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:A
Last Name:DEKLEVA-REBOTTINI
Suffix:
Gender:F
Credentials:MASTERS
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:
Other - Last Name:DEKLEVA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MASTERS
Mailing Address - Street 1:4051 OLD WILLIAM PENN HWY
Mailing Address - Street 2:
Mailing Address - City:MURRYSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15668-1846
Mailing Address - Country:US
Mailing Address - Phone:724-733-8313
Mailing Address - Fax:724-733-8313
Practice Address - Street 1:4051 OLD WILLIAM PENN HWY
Practice Address - Street 2:
Practice Address - City:MURRYSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15668-1846
Practice Address - Country:US
Practice Address - Phone:724-733-8313
Practice Address - Fax:724-733-8313
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS003084-L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA157809Medicare Oscar/Certification