Provider Demographics
NPI:1922599505
Name:DOVE, KATHRYN (LCSW, PHD)
Entity Type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:
Last Name:DOVE
Suffix:
Gender:F
Credentials:LCSW, PHD
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:
Other - Last Name:DOVE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW, PHD
Mailing Address - Street 1:1287 MADISON AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-0573
Mailing Address - Country:US
Mailing Address - Phone:212-722-8940
Mailing Address - Fax:
Practice Address - Street 1:1287 MADISON AVE APT 1
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-0573
Practice Address - Country:US
Practice Address - Phone:212-722-8940
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-19
Last Update Date:2018-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR-032940101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional