Provider Demographics
NPI:1538305818
Name:ENGSTROM, KATE (LCSW)
Entity Type:Individual
Prefix:
First Name:KATE
Middle Name:
Last Name:ENGSTROM
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 1:96 W HOUSTON ST STE 1F
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10012-2553
Mailing Address - Country:US
Mailing Address - Phone:917-510-7118
Mailing Address - Fax:
Practice Address - Street 1:96 W HOUSTON ST STE 1F
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10012-2553
Practice Address - Country:US
Practice Address - Phone:917-510-7118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-17
Last Update Date:2016-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY078375-11041C0700X
IL149.0154021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL149.015402OtherILLINOIS STATE LCSW
NY077260-1OtherLMSW
NY078375-1OtherNEW YORK STATE LCSW
NYA400063156OtherPTAN