Provider Demographics
NPI:1841227659
Name:KANETI, CATHARINE MARIE (PSY D)
Entity Type:Individual
Prefix:DR
First Name:CATHARINE
Middle Name:MARIE
Last Name:KANETI
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4070 LAKE DR SE STE 101
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-8294
Mailing Address - Country:US
Mailing Address - Phone:616-449-2400
Mailing Address - Fax:
Practice Address - Street 1:235 WEALTHY STREET SE
Practice Address - Street 2:MARY FREE BED HOSPITAL
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-5299
Practice Address - Country:US
Practice Address - Phone:616-242-9201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301012699103TR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation