Provider Demographics
NPI:1760138127
Name:KINDER, CATHY MINNIS (LMSW)
Entity Type:Individual
Prefix:
First Name:CATHY
Middle Name:MINNIS
Last Name:KINDER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 ASBURY DR APT SUITE
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-9712
Mailing Address - Country:US
Mailing Address - Phone:607-351-5487
Mailing Address - Fax:
Practice Address - Street 1:11 ASBURY DR
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-9712
Practice Address - Country:US
Practice Address - Phone:160-735-1548
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-24
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY092031-01104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker