Provider Demographics
NPI:1649559261
Name:STEVENS, CATHERINE EMILIA (MS)
Entity Type:Individual
Prefix:MRS
First Name:CATHERINE
Middle Name:EMILIA
Last Name:STEVENS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:337 MERRICK RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:LYNBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11563-2504
Mailing Address - Country:US
Mailing Address - Phone:516-568-2100
Mailing Address - Fax:516-568-2106
Practice Address - Street 1:337 MERRICK RD
Practice Address - Street 2:SUITE 4
Practice Address - City:LYNBROOK
Practice Address - State:NY
Practice Address - Zip Code:11563-2504
Practice Address - Country:US
Practice Address - Phone:516-568-2100
Practice Address - Fax:516-568-2106
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-13
Last Update Date:2011-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist