Basic Information
| Provider Information | |||||||||
| NPI: | 1073848289 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NAAB | ||||||||
| FirstName: | KATHLEEN | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MSW | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | NAAB | ||||||||
| OtherFirstName: | KATIE | ||||||||
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| OtherCredential: | KATHLEEN NAAB | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 3150 ROCHAMBEAU AVE | ||||||||
| Address2: | D 23 | ||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104673803 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6105066822 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 260 E 188TH ST | ||||||||
| Address2: | |||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104585302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7189600260 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/05/2009 | ||||||||
| LastUpdateDate: | 09/13/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 079519 | NY | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.