Provider Demographics
NPI:1982078812
Name:STABNER, KATELYN ANGELA (BS)
Entity Type:Individual
Prefix:MISS
First Name:KATELYN
Middle Name:ANGELA
Last Name:STABNER
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 MAIN ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:GOSHEN
Mailing Address - State:NY
Mailing Address - Zip Code:10924-1636
Mailing Address - Country:US
Mailing Address - Phone:845-458-8661
Mailing Address - Fax:
Practice Address - Street 1:301 MAIN ST
Practice Address - Street 2:SUITE B
Practice Address - City:GOSHEN
Practice Address - State:NY
Practice Address - Zip Code:10924-1636
Practice Address - Country:US
Practice Address - Phone:845-458-8661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-16
Last Update Date:2015-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator