Provider Demographics
NPI:1265669543
Name:PRUDENTE, KATHERINE (LCAT, RDT)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:PRUDENTE
Suffix:
Gender:F
Credentials:LCAT, RDT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 MADISON SQ W STE 1122
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-1629
Mailing Address - Country:US
Mailing Address - Phone:917-410-0467
Mailing Address - Fax:
Practice Address - Street 1:16 MADISON SQ W STE 1122
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-1629
Practice Address - Country:US
Practice Address - Phone:917-410-0467
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-15
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001210-1221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist