Provider Demographics
NPI:1922215987
Name:ROE, KATHY GIBSON (MA, PSYA)
Entity type:Individual
Prefix:MS
First Name:KATHY
Middle Name:GIBSON
Last Name:ROE
Suffix:
Gender:F
Credentials:MA, PSYA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 W 95TH ST
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-6611
Mailing Address - Country:US
Mailing Address - Phone:212-222-9228
Mailing Address - Fax:
Practice Address - Street 1:600 W 111TH ST
Practice Address - Street 2:APT. 1B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-1813
Practice Address - Country:US
Practice Address - Phone:212-222-9228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPERMIT P56450102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst