Provider Demographics
NPI:1740899160
Name:SIDIBE, KADIATOU
Entity type:Individual
Prefix:
First Name:KADIATOU
Middle Name:
Last Name:SIDIBE
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 1:16 S MESIER AVE
Mailing Address - Street 2:
Mailing Address - City:WAPPINGERS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12590-2719
Mailing Address - Country:US
Mailing Address - Phone:845-518-8009
Mailing Address - Fax:
Practice Address - Street 1:216 E 45TH ST RM 1101
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-3304
Practice Address - Country:US
Practice Address - Phone:845-518-8009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-31
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY099833101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health