Provider Demographics
NPI:1346732567
Name:KING-PETRELLESE, KASEY (LMFT)
Entity Type:Individual
Prefix:
First Name:KASEY
Middle Name:
Last Name:KING-PETRELLESE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:667 STONELEIGH AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:NY
Mailing Address - Zip Code:10512-2455
Mailing Address - Country:US
Mailing Address - Phone:845-279-5908
Mailing Address - Fax:845-279-5447
Practice Address - Street 1:667 STONELEIGH AVE STE 202
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:NY
Practice Address - Zip Code:10512-2455
Practice Address - Country:US
Practice Address - Phone:845-279-5908
Practice Address - Fax:845-279-5447
Is Sole Proprietor?:No
Enumeration Date:2018-06-04
Last Update Date:2018-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001485106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist