Provider Demographics
NPI:1457578650
Name:KEATING, CATHERINE THERESA (RD, CDN)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:THERESA
Last Name:KEATING
Suffix:
Gender:F
Credentials:RD, CDN
Other - Prefix:
Other - First Name:CATHERINE
Other - Middle Name:THERESA
Other - Last Name:KEATING-STAUCH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RD, CDN
Mailing Address - Street 1:17 CASTLEBERRY DR
Mailing Address - Street 2:
Mailing Address - City:GANSEVOORT
Mailing Address - State:NY
Mailing Address - Zip Code:12831-2509
Mailing Address - Country:US
Mailing Address - Phone:518-584-8958
Mailing Address - Fax:
Practice Address - Street 1:211 CHURCH ST
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-1046
Practice Address - Country:US
Practice Address - Phone:518-583-8372
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5357529133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYRA7204Medicaid