Provider Demographics
NPI:1730901349
Name:PETRONE, CATHERINE JUNE
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:JUNE
Last Name:PETRONE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572-1105
Mailing Address - Country:US
Mailing Address - Phone:516-615-9370
Mailing Address - Fax:
Practice Address - Street 1:2900 CHARLES ST
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:NY
Practice Address - Zip Code:11572-1105
Practice Address - Country:US
Practice Address - Phone:516-615-9370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-26
Last Update Date:2024-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001226102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst