Provider Demographics
NPI:1568577542
Name:VOURKAS, CATHERINE MARIE BRATTON (MSW)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:MARIE BRATTON
Last Name:VOURKAS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:CATHLEEN
Other - Middle Name:
Other - Last Name:ALVIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:19416A 64TH AVE
Mailing Address - Street 2:APT. #3A
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11365-2833
Mailing Address - Country:US
Mailing Address - Phone:718-454-6370
Mailing Address - Fax:
Practice Address - Street 1:11015 71ST RD
Practice Address - Street 2:APT. #1J
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-4951
Practice Address - Country:US
Practice Address - Phone:718-454-6370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR021905-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN8986OtherBLUE CROSS/BLUE SHIELD
NYP570985OtherOXFORD PROVIDER #
NY0059315OtherGHI PROVIDER #
NMR28256Medicare UPIN
NM59315Medicare ID - Type UnspecifiedMEDICARE #