Provider Demographics
NPI:1851794689
Name:QUEEN, KATHRYN (MS LAC, LMT)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:QUEEN
Suffix:
Gender:F
Credentials:MS LAC, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 E 65TH ST APT 3D
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-7120
Mailing Address - Country:US
Mailing Address - Phone:347-526-2275
Mailing Address - Fax:
Practice Address - Street 1:50 W 72ND ST APT 801
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-4255
Practice Address - Country:US
Practice Address - Phone:347-526-2275
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-07
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005385171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist