Provider Demographics
NPI:1932570090
Name:VALENCIA, KATHRYN L (CASAC 23867)
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:L
Last Name:VALENCIA
Suffix:
Gender:F
Credentials:CASAC 23867
Other - Prefix:MRS
Other - First Name:KATHRYN
Other - Middle Name:L
Other - Last Name:VALENCIA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN 10 277554
Mailing Address - Street 1:8 INLAND CT
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:NY
Mailing Address - Zip Code:10512-6441
Mailing Address - Country:US
Mailing Address - Phone:914-666-0191
Mailing Address - Fax:914-666-9107
Practice Address - Street 1:116 RADIO CIRCLE DR
Practice Address - Street 2:SUITE 309
Practice Address - City:MOUNT KISCO
Practice Address - State:NY
Practice Address - Zip Code:10549-2616
Practice Address - Country:US
Practice Address - Phone:914-666-0191
Practice Address - Fax:914-666-9107
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-15
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY23867251S00000X
NY10 277554164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00729997Medicaid