Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TB0200X | Cognitive & Behavioral Psychologist | PS019410 | PA |
Y | 103G00000X | Clinical Psychologist | PS019410 | PA |
Y | 103TC0700X | Clinical Psychologist | PS019410 | PA |
NPI | 1184378416 |
---|---|
Provider Name | Dr. Gabriela Kattan Khazanov |
First Address | Philadelphia, PA 19146-2603 |
Second Address | Philadelphia, PA 19146-2603 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/02/2022 |
Last Update Date | 06/02/2022 |