Provider Demographics
NPI:1043424674
Name:GARVEY, KATHLEEN I
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:I
Last Name:GARVEY
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 1:191 LANCASHIRE PL
Mailing Address - Street 2:
Mailing Address - City:S4847CHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12309
Mailing Address - Country:US
Mailing Address - Phone:518-395-2021
Mailing Address - Fax:
Practice Address - Street 1:191 LANCASHIRE PL
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12309-4847
Practice Address - Country:US
Practice Address - Phone:518-395-2021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY198152-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02144461Medicaid