Basic Information
| Provider Information | |||||||||
| NPI: | 1922734110 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RIOS VALDEZ | ||||||||
| FirstName: | KATHERYN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1562 LYDIA AVE | ||||||||
| Address2: | |||||||||
| City: | ELMONT | ||||||||
| State: | NY | ||||||||
| PostalCode: | 110034423 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7186379225 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4308 52ND ST FL 2 | ||||||||
| Address2: | |||||||||
| City: | WOODSIDE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113774542 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7184584243 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/28/2022 | ||||||||
| LastUpdateDate: | 07/28/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/28/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.