Provider Demographics
NPI:1811919780
Name:POPPE, KATHERINE TERESA (CTRS, LMSW)
Entity type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:TERESA
Last Name:POPPE
Suffix:
Gender:F
Credentials:CTRS, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 KATHERINE PL
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11769-1704
Mailing Address - Country:US
Mailing Address - Phone:516-901-3417
Mailing Address - Fax:
Practice Address - Street 1:20 KATHERINE PL
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:NY
Practice Address - Zip Code:11769-1704
Practice Address - Country:US
Practice Address - Phone:516-901-3417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-23
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225800000X
NY086606-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist