Provider Demographics
NPI:1255831475
Name:TAYLOR, KATHLEEN MATTRAN (PHD)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:MATTRAN
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 E 57TH ST STE 1101
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-2962
Mailing Address - Country:US
Mailing Address - Phone:212-308-2440
Mailing Address - Fax:
Practice Address - Street 1:136 E 57TH ST STE 1101
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-2962
Practice Address - Country:US
Practice Address - Phone:212-308-2440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-14
Last Update Date:2018-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022573103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical