Provider Demographics
NPI:1790379063
Name:NOLAN, CATHERINE STANFORD
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:STANFORD
Last Name:NOLAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CATHERINE
Other - Middle Name:THERESA
Other - Last Name:STANFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:631 E 18TH ST APT 4C
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-7677
Mailing Address - Country:US
Mailing Address - Phone:917-974-6613
Mailing Address - Fax:
Practice Address - Street 1:631 E 18TH ST APT 4C
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-7677
Practice Address - Country:US
Practice Address - Phone:917-974-6613
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-26
Last Update Date:2022-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY108340-01104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker