Provider Demographics
NPI:1508081811
Name:NATHANSON, KAY S (LCSW)
Entity Type:Individual
Prefix:MS
First Name:KAY
Middle Name:S
Last Name:NATHANSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:272 CANOPUS HOLLOW ROAD
Mailing Address - Street 2:
Mailing Address - City:PUTNAM VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10579-1406
Mailing Address - Country:US
Mailing Address - Phone:845-526-4934
Mailing Address - Fax:
Practice Address - Street 1:272 CANOPUS HOLLOW ROAD
Practice Address - Street 2:
Practice Address - City:PUTNAM VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10579-1406
Practice Address - Country:US
Practice Address - Phone:845-526-4934
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR01290711041C0700X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN2L473OtherBLUE CROSS BLUE SHIELD
NY265643OtherVALUE OPTIONS
NYP1219283OtherOXFORD HEALTH PLANS
NY7482504OtherGHI
NY178297OtherMHN
NY778597OtherTHE HOLMAN GROUP
NYN2L471OtherBLUE CROSS BLUE SHIELD
NY2132301OtherAETNA
NYN2L472OtherBLUE CROSS BLUE SHIELD
NY2132301OtherAETNA
NY265643OtherVALUE OPTIONS