Provider Demographics
NPI:1871663922
Name:CHITTENDEN, KATHARINE SPENCER (PSY M)
Entity Type:Individual
Prefix:
First Name:KATHARINE
Middle Name:SPENCER
Last Name:CHITTENDEN
Suffix:
Gender:F
Credentials:PSY M
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2060 NARRAGANSETT AVE
Mailing Address - Street 2:FIRST FLOOR
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-1742
Mailing Address - Country:US
Mailing Address - Phone:914-882-9389
Mailing Address - Fax:
Practice Address - Street 1:1400 PELHAM PKWY S
Practice Address - Street 2:NURSES RESIDENCE - 3S18
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-1138
Practice Address - Country:US
Practice Address - Phone:718-918-3748
Practice Address - Fax:718-918-7185
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist