Provider Demographics
NPI:1306833603
Name:KATEHIS, TULLA (LCSW)
Entity Type:Individual
Prefix:
First Name:TULLA
Middle Name:
Last Name:KATEHIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 HEMPSTEAD AVE
Mailing Address - Street 2:SUITE 249
Mailing Address - City:RVC
Mailing Address - State:NY
Mailing Address - Zip Code:11570-4033
Mailing Address - Country:US
Mailing Address - Phone:516-379-9098
Mailing Address - Fax:516-379-9098
Practice Address - Street 1:3477 COLONY DR
Practice Address - Street 2:3477 COLONY DRIVE
Practice Address - City:BALDWIN
Practice Address - State:NY
Practice Address - Zip Code:11510-5117
Practice Address - Country:US
Practice Address - Phone:516-632-9398
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR049902-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYNOH362Medicare ID - Type Unspecified