Provider Demographics
NPI:1649832445
Name:NIEGOCKI, KATHLEEN LOUISE (PHD)
Entity type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:LOUISE
Last Name:NIEGOCKI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:780 RIVERSIDE DR APT 6FF
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-0397
Mailing Address - Country:US
Mailing Address - Phone:917-697-2296
Mailing Address - Fax:
Practice Address - Street 1:240 W 102ND ST APT 15
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-4924
Practice Address - Country:US
Practice Address - Phone:929-265-2558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-01
Last Update Date:2019-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021506103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling