Provider Demographics
NPI:1497938377
Name:KATSAMANIS, IRENE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:IRENE
Middle Name:
Last Name:KATSAMANIS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13301 BOOTH MEMORIAL AVE
Mailing Address - Street 2:8A
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-5135
Mailing Address - Country:US
Mailing Address - Phone:718-309-3945
Mailing Address - Fax:
Practice Address - Street 1:307 E 105TH ST
Practice Address - Street 2:1S
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-5015
Practice Address - Country:US
Practice Address - Phone:718-309-3945
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-13
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017424103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist