Provider Demographics
NPI:1427427525
Name:SROKA, KATHARINE
Entity type:Individual
Prefix:
First Name:KATHARINE
Middle Name:
Last Name:SROKA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1349 E 79TH ST
Mailing Address - Street 2:ROOM 115
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44103-2864
Mailing Address - Country:US
Mailing Address - Phone:216-838-0290
Mailing Address - Fax:216-523-6309
Practice Address - Street 1:1349 E 79TH ST
Practice Address - Street 2:ROOM 115
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44103-2864
Practice Address - Country:US
Practice Address - Phone:216-838-0290
Practice Address - Fax:216-523-6309
Is Sole Proprietor?:No
Enumeration Date:2015-09-18
Last Update Date:2015-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH3199420103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool