Provider Demographics
NPI:1285830364
Name:ANDERSON, KATHLEEN SUSAN (RN)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:SUSAN
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:43 ROLLING RIDGE ROAD
Mailing Address - Street 2:
Mailing Address - City:HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12538
Mailing Address - Country:US
Mailing Address - Phone:845-849-3542
Mailing Address - Fax:
Practice Address - Street 1:230 NORTH ROAD
Practice Address - Street 2:LEXINGTON CENTER FOR RECOVERY MMTP
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601
Practice Address - Country:US
Practice Address - Phone:845-486-2850
Practice Address - Fax:845-486-2770
Is Sole Proprietor?:No
Enumeration Date:2007-06-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3666721163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)