Individual
DR. VIRGINIA M. KOUTSOUROS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSY.D.
Contact information
Practice address
5619-25 VINE STREET, PHILADELPHIA, PA 19139-1302
(215) 471-2761
(215) 471-2929
Mailing address
1006 STRATFORD AVE, MELROSE PARK, PA 19027-3025
(215) 782-8972
(215) 635-3087
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PS015772
PA
Other
Enumeration date
08/21/2006
Last updated
04/10/2013
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