Virginia M. Koutsouros, PSY.D.

Primary specialty

PsychologistTaxonomy code 103T00000X

License

PS015772 Issued in PA

Practice address

5619-25 Vine Street
Philadelphia, PA 19139-1302

Phone

(215) 471-2761

Fax

(215) 471-2929

NPI assigned

Aug 21, 2006

Last updated

Apr 10, 2013By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Spectrum Health Services, Inc.

  dba Spectrum Health Rx

  • Community/Retail Pharmacy
  • Philadelphia, PA
  • NPI 1164300901
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156118400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1365552000000",
    "number": "1609982982",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1006 STRATFORD AVE",
            "city": "MELROSE PARK",
            "state": "PA",
            "postal_code": "190273025",
            "telephone_number": "215-782-8972",
            "fax_number": "215-635-3087"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5619-25 VINE STREET",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191391302",
            "telephone_number": "215-471-2761",
            "fax_number": "215-471-2929"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOUTSOUROS",
        "first_name": "VIRGINIA",
        "middle_name": "M.",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-21",
        "last_updated": "2013-04-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "PA",
            "license": "PS015772",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alexa Kourafas
• Alison Nicole Kourlesis, PA-C
• Peter T. Kousoulis, D.M.D.
• Alexis Anna-May Koutroulakis, L.C.S.W.
• Alexandra Sophia Koutsoubis, MD
• Demi Nicole Kouvaris
• Letitia Danielle Kouvatas, PSY.D.
• Tasha Kouvatsos, M.D.
• Jessica Graham Kovach, MD
• Stephen John Kovach III, MD

• Psychologist in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Psychologist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.