Provider Demographics
NPI:1407584667
Name:MOTTO, KATHLEEN A
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:A
Last Name:MOTTO
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 1:318 BOUNDARY AVE FL 1
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-5036
Mailing Address - Country:US
Mailing Address - Phone:917-882-3575
Mailing Address - Fax:
Practice Address - Street 1:318 BOUNDARY AVE FL 1
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-5036
Practice Address - Country:US
Practice Address - Phone:917-882-3575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-15
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency