Basic Information
| Provider Information | |||||||||
| NPI: | 1144543547 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARTIN | ||||||||
| FirstName: | KAFY-ANN | ||||||||
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| Credential: | M.S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3344 WICKHAM AVE | ||||||||
| Address2: | |||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104692736 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7185198603 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2534 STEINWAY ST | ||||||||
| Address2: | |||||||||
| City: | ASTORIA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 111033702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7187775243 | ||||||||
| FaxNumber: | 7187775250 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/12/2010 | ||||||||
| LastUpdateDate: | 03/12/2010 | ||||||||
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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 | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.