Provider Demographics
NPI:1407164973
Name:KATSAVDAKIS, KOSTAS ANDREAS
Entity Type:Individual
Prefix:DR
First Name:KOSTAS
Middle Name:ANDREAS
Last Name:KATSAVDAKIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:276 5TH AVENUE
Mailing Address - Street 2:SUITE 905
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-4509
Mailing Address - Country:US
Mailing Address - Phone:212-571-4249
Mailing Address - Fax:212-571-4176
Practice Address - Street 1:276 5TH AVE
Practice Address - Street 2:SUITE 905
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-4509
Practice Address - Country:US
Practice Address - Phone:212-571-4249
Practice Address - Fax:212-571-4176
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-18
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015018-1103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist