Provider Demographics
NPI:1790520690
Name:WRIGHT, KATERI
Entity type:Individual
Prefix:
First Name:KATERI
Middle Name:
Last Name:WRIGHT
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 1:5821 43RD AVE APT 9B
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-4803
Mailing Address - Country:US
Mailing Address - Phone:917-325-6025
Mailing Address - Fax:
Practice Address - Street 1:5821 43RD AVE APT 9B
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-4803
Practice Address - Country:US
Practice Address - Phone:917-325-6025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-01
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician