Provider Demographics
NPI:1528314952
Name:SHRAGER, KATHERINE FAYE BRESLOW (PSYD)
Entity type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:FAYE BRESLOW
Last Name:SHRAGER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 BALA AVE
Mailing Address - Street 2:
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-3307
Mailing Address - Country:US
Mailing Address - Phone:484-557-7257
Mailing Address - Fax:
Practice Address - Street 1:105 BALA AVE
Practice Address - Street 2:
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-3307
Practice Address - Country:US
Practice Address - Phone:484-557-7257
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-03
Last Update Date:2012-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS016780103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist