Provider Demographics
NPI:1790382398
Name:FAULKNER, KATELYNN MARIE (PSYD)
Entity Type:Individual
Prefix:
First Name:KATELYNN
Middle Name:MARIE
Last Name:FAULKNER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 OLD PLANK RD # 1D
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:NY
Mailing Address - Zip Code:13323-1802
Mailing Address - Country:US
Mailing Address - Phone:716-474-0076
Mailing Address - Fax:
Practice Address - Street 1:1 OLD PLANK RD # 1D
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:NY
Practice Address - Zip Code:13323-1802
Practice Address - Country:US
Practice Address - Phone:716-474-0076
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-06
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023892-01103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty