Provider Demographics
NPI:1912211400
Name:BESIG, KATIE A (MA)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:A
Last Name:BESIG
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 MOHAWK STREET
Mailing Address - Street 2:
Mailing Address - City:TUPPER LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:12986
Mailing Address - Country:US
Mailing Address - Phone:518-354-2921
Mailing Address - Fax:
Practice Address - Street 1:12 MOHAWK STREET
Practice Address - Street 2:
Practice Address - City:TUPPER LAKE
Practice Address - State:NY
Practice Address - Zip Code:12986
Practice Address - Country:US
Practice Address - Phone:518-354-2921
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-27
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1207921103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool