Provider Demographics
NPI:1891839221
Name:MORTIERE, CATHERINE MARY (PHD)
Entity Type:Individual
Prefix:DR
First Name:CATHERINE
Middle Name:MARY
Last Name:MORTIERE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 E 105TH ST
Mailing Address - Street 2:#1S
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-5015
Mailing Address - Country:US
Mailing Address - Phone:212-289-3613
Mailing Address - Fax:
Practice Address - Street 1:307 E 105TH ST
Practice Address - Street 2:#1S
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-5015
Practice Address - Country:US
Practice Address - Phone:212-289-3613
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-18
Last Update Date:2010-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY68 015723103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic