Believe it or not, yes. Delaware and Pennsylvania both tax a telecommuter who works for a company in their state remotely from home as a nonresident. Kentucky does not, but the patient was physically in PA at the time he was receiving the counselling, so this is considered PA income. Delaware also taxes you on that income, but you should receive a credit on your DE return for the tax you pay to PA on this income you made that's taxable to PA.