MEDICARE: KATHRYN BOOKER LCSW

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	1041C0700X	Clinical Social Worker	090652	NY

General Provider Information

NPI Number	:	1841715059
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHRYN BOOKER LCSW

Provider Business Mailing Address
First Line	:	474 NIAGARA FALLS BLVD STE 5
Second Line	:
City	:	TONAWANDA
State	:	NY
Zip	:	14223-2647
Country	:	US
Telephone Number	:	716-491-6516
Fax Number	:

Provider Business Practice Location Address
First Line	:	474 NIAGARA FALLS BLVD STE 5
Second Line	:
City	:	TONAWANDA
State	:	NY
Zip	:	14223-2647
Country	:	US
Telephone Number	:	716-491-6516
Fax Number	:

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

Provider Enumeration Date	:	08/08/2017
Last Update Date	:	02/11/2022

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