Provider Demographics
NPI:1881905040
Name:DEFAYETTE, CATHERINE DIANE (MA, CAS)
Entity type:Individual
Prefix:MRS
First Name:CATHERINE
Middle Name:DIANE
Last Name:DEFAYETTE
Suffix:
Gender:F
Credentials:MA, CAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 SAND RD
Mailing Address - Street 2:
Mailing Address - City:MORRISONVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12962-2924
Mailing Address - Country:US
Mailing Address - Phone:518-565-5980
Mailing Address - Fax:518-565-5972
Practice Address - Street 1:47 SAND RD
Practice Address - Street 2:
Practice Address - City:MORRISONVILLE
Practice Address - State:NY
Practice Address - Zip Code:12962-2924
Practice Address - Country:US
Practice Address - Phone:518-565-5980
Practice Address - Fax:518-565-5972
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-23
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY608893951103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool