MEDICARE: CATHERINE STANFORD NOLAN

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	104100000X	Social Worker	108340-01	NY

General Provider Information

NPI Number	:	1790379063
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CATHERINE STANFORD NOLAN

Provider Business Mailing Address
First Line	:	631 E 18TH ST APT 4C
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11226-7677
Country	:	US
Telephone Number	:	917-974-6613
Fax Number	:

Provider Business Practice Location Address
First Line	:	631 E 18TH ST APT 4C
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11226-7677
Country	:	US
Telephone Number	:	917-974-6613
Fax Number	:

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

Provider Enumeration Date	:	02/26/2021
Last Update Date	:	12/30/2022

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