Provider Demographics
NPI:1831617117
Name:MAFFETONE, KATHERINE (AUD)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:MAFFETONE
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 CROSSWAYS PARK DR STE 101
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11797-2044
Mailing Address - Country:US
Mailing Address - Phone:516-364-0011
Mailing Address - Fax:
Practice Address - Street 1:113 CROSSWAYS PARK DR STE 101
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NY
Practice Address - Zip Code:11797-2044
Practice Address - Country:US
Practice Address - Phone:516-364-0011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-06
Last Update Date:2018-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002735231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist