Provider Demographics
NPI:1245974948
Name:ANDERSON, KATHERINE MARIE (LMSW)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:MARIE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 W 235TH ST APT 3D
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-1740
Mailing Address - Country:US
Mailing Address - Phone:909-201-3496
Mailing Address - Fax:
Practice Address - Street 1:525 W 235TH ST APT 3D
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-1740
Practice Address - Country:US
Practice Address - Phone:909-201-3496
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-27
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY100425104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker