Provider Demographics
NPI:1356967533
Name:STEWART, KATHERINE ELLEN (MHC-LP)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ELLEN
Last Name:STEWART
Suffix:
Gender:F
Credentials:MHC-LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:459 COLUMBUS AVE STE 124
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-5129
Mailing Address - Country:US
Mailing Address - Phone:866-525-2766
Mailing Address - Fax:
Practice Address - Street 1:459 COLUMBUS AVE STE 124
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-5129
Practice Address - Country:US
Practice Address - Phone:866-525-2766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-23
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY110689-01101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program