Provider Demographics
NPI:1861034670
Name:MAMBATHA, ATHENA HELEN
Entity Type:Individual
Prefix:MRS
First Name:ATHENA
Middle Name:HELEN
Last Name:MAMBATHA
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 1:265 SAW MILL RIVER RD
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:NY
Mailing Address - Zip Code:10532-1509
Mailing Address - Country:US
Mailing Address - Phone:914-495-4565
Mailing Address - Fax:
Practice Address - Street 1:265 SAW MILL RIVER RD
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:NY
Practice Address - Zip Code:10532-1509
Practice Address - Country:US
Practice Address - Phone:914-495-4565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-14
Last Update Date:2019-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator