Provider Demographics
NPI:1619338639
Name:KOULIAKI, AIKATERINI
Entity Type:Individual
Prefix:
First Name:AIKATERINI
Middle Name:
Last Name:KOULIAKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:708 SAW MILL RIVER RD APT 1C
Mailing Address - Street 2:
Mailing Address - City:ARDSLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10502-1817
Mailing Address - Country:US
Mailing Address - Phone:646-531-5904
Mailing Address - Fax:
Practice Address - Street 1:708 SAW MILL RIVER RD APT 1C
Practice Address - Street 2:
Practice Address - City:ARDSLEY
Practice Address - State:NY
Practice Address - Zip Code:10502-1817
Practice Address - Country:US
Practice Address - Phone:646-531-5904
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-18
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
NY008658101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health