Basic Information
Provider Information
NPI: 1770563363
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: POPPITI
FirstName: KATHRYN
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: LPC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: BOX 30170
Address2:  
City: WILMINGTON
State: DE
PostalCode: 19805
CountryCode: US
TelephoneNumber: 3026237362
FaxNumber: 3026237374
Practice Location
Address1: 501 W 14TH ST
Address2: 3RD FLOOR
City: WILMINGTON
State: DE
PostalCode: 198011013
CountryCode: US
TelephoneNumber: 3024282100
FaxNumber: 3024282121
Other Information
ProviderEnumerationDate: 01/19/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YP2500XP10000079DEY Behavioral Health & Social Service ProvidersCounselorProfessional

No ID Information.


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