Provider Demographics
NPI:1023734779
Name:HANNAN, KATHERINE (MS, R-DMT, LCAT)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:HANNAN
Suffix:
Gender:F
Credentials:MS, R-DMT, LCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 OAKWOOD RD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-4231
Mailing Address - Country:US
Mailing Address - Phone:866-232-7328
Mailing Address - Fax:
Practice Address - Street 1:22 OAKWOOD RD
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-4231
Practice Address - Country:US
Practice Address - Phone:866-232-7328
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-14
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000200221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist