Provider Demographics
NPI:1376849000
Name:BRONDOLO, KATHRYN ANN (LCSWR)
Entity Type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:ANN
Last Name:BRONDOLO
Suffix:
Gender:F
Credentials:LCSWR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 PARROTT RD
Mailing Address - Street 2:
Mailing Address - City:WEST NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10994-1025
Mailing Address - Country:US
Mailing Address - Phone:845-627-4821
Mailing Address - Fax:
Practice Address - Street 1:65 PARROTT RD
Practice Address - Street 2:
Practice Address - City:WEST NYACK
Practice Address - State:NY
Practice Address - Zip Code:10994-1025
Practice Address - Country:US
Practice Address - Phone:845-627-4821
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-27
Last Update Date:2011-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR034281104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker