Provider Demographics
NPI:1326471582
Name:BAEZ-KAMMERMAN, CATHERINE
Entity Type:Individual
Prefix:MISS
First Name:CATHERINE
Middle Name:
Last Name:BAEZ-KAMMERMAN
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 1:105 WINANT ST
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10303-2731
Mailing Address - Country:US
Mailing Address - Phone:917-331-2634
Mailing Address - Fax:
Practice Address - Street 1:105 WINANT ST
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10303-2731
Practice Address - Country:US
Practice Address - Phone:917-331-2634
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-12
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY839097103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst