Provider Demographics
NPI:1497963847
Name:ANDERSON-HANLEY, CATHERINE (PHD)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:ANDERSON-HANLEY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 USHERS RD STE 8
Mailing Address - Street 2:
Mailing Address - City:BALLSTON LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:12019-1547
Mailing Address - Country:US
Mailing Address - Phone:518-581-7260
Mailing Address - Fax:518-633-1218
Practice Address - Street 1:315 USHERS RD STE 8
Practice Address - Street 2:
Practice Address - City:BALLSTON LAKE
Practice Address - State:NY
Practice Address - Zip Code:12019-1547
Practice Address - Country:US
Practice Address - Phone:518-581-7260
Practice Address - Fax:518-633-1218
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2019-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013031103T00000X, 103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY350759OtherMVP #
NY10030925OtherCDPHP #
NY680016327OtherRAILROAD MEDICARE CARRIER
NY000471256001OtherBLUE SHIELD NENY
NY01972169Medicaid
NY10030925OtherCDPHP #