Provider Demographics
NPI:1629844071
Name:STALEY, KATHRYN FLORINE (LP)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:FLORINE
Last Name:STALEY
Suffix:
Gender:F
Credentials:LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 E 88TH ST APT 15B
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-1152
Mailing Address - Country:US
Mailing Address - Phone:631-457-9249
Mailing Address - Fax:
Practice Address - Street 1:47 E 88TH ST APT 15B
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-1152
Practice Address - Country:US
Practice Address - Phone:631-457-9249
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-28
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000922103TP0814X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysis