Provider Demographics
NPI:1194924407
Name:ERVINEVANGELISTE, KATHERINE LEE
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:LEE
Last Name:ERVINEVANGELISTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KATHEY
Other - Middle Name:L
Other - Last Name:ERVIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED,LPC
Mailing Address - Street 1:407 OAK ST
Mailing Address - Street 2:
Mailing Address - City:IRWIN
Mailing Address - State:PA
Mailing Address - Zip Code:15642-3523
Mailing Address - Country:US
Mailing Address - Phone:724-863-6555
Mailing Address - Fax:724-863-6559
Practice Address - Street 1:407 OAK ST
Practice Address - Street 2:
Practice Address - City:IRWIN
Practice Address - State:PA
Practice Address - Zip Code:15642-3523
Practice Address - Country:US
Practice Address - Phone:724-863-6555
Practice Address - Fax:724-863-6559
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-16
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC000396101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional