Provider Demographics
NPI:1437860368
Name:CHERRY, KATHLEEN MEGHAN (SEP)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:MEGHAN
Last Name:CHERRY
Suffix:
Gender:F
Credentials:SEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 BEDFORD AVE # 127
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11211-4171
Mailing Address - Country:US
Mailing Address - Phone:917-697-5116
Mailing Address - Fax:
Practice Address - Street 1:109 N 12TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11249-1002
Practice Address - Country:US
Practice Address - Phone:347-970-6757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-12
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach