Provider Demographics
NPI:1972645539
Name:DIFULVIO KAEPPLINGER, KATHLEEN P (LCSW R)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:P
Last Name:DIFULVIO KAEPPLINGER
Suffix:
Gender:F
Credentials:LCSW R
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:P
Other - Last Name:DIFULVIO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW R
Mailing Address - Street 1:7 MACOMBER AVENUE
Mailing Address - Street 2:
Mailing Address - City:BIGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13901-1910
Mailing Address - Country:US
Mailing Address - Phone:607-341-2653
Mailing Address - Fax:
Practice Address - Street 1:552 CHENANGO STREET FIRST FLOOR
Practice Address - Street 2:
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13901
Practice Address - Country:US
Practice Address - Phone:607-341-2653
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR038281104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000022242OtherEXCELLUS
NY249351OtherVALUE OPTIONS GHI
NY02314170Medicaid
NY02314170Medicaid