Provider Demographics
NPI:1013317429
Name:PRIKAZSKY, KATHRINE (LCSW)
Entity Type:Individual
Prefix:
First Name:KATHRINE
Middle Name:
Last Name:PRIKAZSKY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 PADEN ST
Mailing Address - Street 2:
Mailing Address - City:ENDICOTT
Mailing Address - State:NY
Mailing Address - Zip Code:13760-4531
Mailing Address - Country:US
Mailing Address - Phone:607-757-2137
Mailing Address - Fax:
Practice Address - Street 1:715 PADEN ST
Practice Address - Street 2:
Practice Address - City:ENDICOTT
Practice Address - State:NY
Practice Address - Zip Code:13760-4531
Practice Address - Country:US
Practice Address - Phone:607-757-2137
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-04
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0798491041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool