Provider Demographics
NPI:1972859411
Name:COONRADT, CATHERINE A (MSSPED)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:A
Last Name:COONRADT
Suffix:
Gender:F
Credentials:MSSPED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 EXCELSIOR AVE
Mailing Address - Street 2:LEFT APT
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12180-5206
Mailing Address - Country:US
Mailing Address - Phone:518-274-0134
Mailing Address - Fax:
Practice Address - Street 1:597 3RD AVE
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12182-2509
Practice Address - Country:US
Practice Address - Phone:518-233-0544
Practice Address - Fax:518-233-0703
Is Sole Proprietor?:No
Enumeration Date:2012-08-02
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist