Provider Demographics
NPI:1902978042
Name:LASKA, KATHY FIXMAN I (CSW)
Entity Type:Individual
Prefix:MRS
First Name:KATHY
Middle Name:FIXMAN
Last Name:LASKA
Suffix:I
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:465 BEDFORD ROAD
Mailing Address - Street 2:
Mailing Address - City:CHAPPAQUA
Mailing Address - State:NY
Mailing Address - Zip Code:10514
Mailing Address - Country:US
Mailing Address - Phone:914-238-3509
Mailing Address - Fax:914-238-1716
Practice Address - Street 1:465 BEDFORD ROAD
Practice Address - Street 2:
Practice Address - City:CHAPPAQUA
Practice Address - State:NY
Practice Address - Zip Code:10514
Practice Address - Country:US
Practice Address - Phone:914-238-3509
Practice Address - Fax:914-238-1716
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2015-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY24817R1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY11236777OtherCAQH STANDARD CREDENTIALI