Provider Demographics
NPI:1013292010
Name:PACHECO, KETTY CARMEN
Entity Type:Individual
Prefix:
First Name:KETTY
Middle Name:CARMEN
Last Name:PACHECO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2537 GRAND CONCOURSE
Mailing Address - Street 2:C3S
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10468-4651
Mailing Address - Country:US
Mailing Address - Phone:718-681-2280
Mailing Address - Fax:
Practice Address - Street 1:2537 GRAND CONCOURSE
Practice Address - Street 2:C3S
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10468-4651
Practice Address - Country:US
Practice Address - Phone:718-681-2280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-21
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health