Provider Demographics
NPI:1851522569
Name:KATTELL, CONSTANCE E
Entity Type:Individual
Prefix:
First Name:CONSTANCE
Middle Name:E
Last Name:KATTELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3633 MATTHEWS DR
Mailing Address - Street 2:
Mailing Address - City:ENDWELL
Mailing Address - State:NY
Mailing Address - Zip Code:13760-1623
Mailing Address - Country:US
Mailing Address - Phone:607-765-2427
Mailing Address - Fax:
Practice Address - Street 1:3633 MATTHEWS DR
Practice Address - Street 2:
Practice Address - City:ENDWELL
Practice Address - State:NY
Practice Address - Zip Code:13760-1623
Practice Address - Country:US
Practice Address - Phone:607-765-2427
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-29
Last Update Date:2009-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031515-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical