MEDICARE: KATRINA LIVANOS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1689921850
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATRINA LIVANOS

Provider Business Mailing Address
First Line	:	337 E 74TH ST
Second Line	:	APT. 3G
City	:	NEW YORK
State	:	NY
Zip	:	10021-3792
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	201 E 19TH ST APT 17F
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10003-2633
Country	:	US
Telephone Number	:	317-965-5314
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/07/2012
Last Update Date	:	09/14/2018

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Directions to “ KATRINA LIVANOS ” Practice Location

Language	Start Address	Practice Location

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