Provider Demographics
NPI:1306982970
Name:KOOSER, TINA E (PHD)
Entity type:Individual
Prefix:DR
First Name:TINA
Middle Name:E
Last Name:KOOSER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:624 ALEX CT
Mailing Address - Street 2:
Mailing Address - City:CRANBERRY TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:16066-7918
Mailing Address - Country:US
Mailing Address - Phone:724-316-2131
Mailing Address - Fax:724-452-0184
Practice Address - Street 1:624 ALEX CT
Practice Address - Street 2:
Practice Address - City:CRANBERRY TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:16066-7918
Practice Address - Country:US
Practice Address - Phone:724-316-2131
Practice Address - Fax:724-452-0184
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS007822L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical