Provider Demographics
NPI:1710674874
Name:TETTEMER, APRIL MEREDITH (LCAT)
Entity Type:Individual
Prefix:MS
First Name:APRIL
Middle Name:MEREDITH
Last Name:TETTEMER
Suffix:
Gender:F
Credentials:LCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:332 E 95TH ST APT 21
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-5729
Mailing Address - Country:US
Mailing Address - Phone:570-242-0761
Mailing Address - Fax:
Practice Address - Street 1:2024 WILLIAMSBRIDGE RD STE 3
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-1631
Practice Address - Country:US
Practice Address - Phone:917-992-1569
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-19
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002790221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt TherapistGroup - Multi-Specialty