Healthcare Provider Details

I. General information

NPI: 1134799554
Provider Name (Legal Business Name): KATHLEEN ELIZABETH WHITLOCK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2021
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 ACADEMY RD
ALBANY NY
12208-3198
US

IV. Provider business mailing address

60 ACADEMY RD
ALBANY NY
12208-3103
US

V. Phone/Fax

Practice location:
  • Phone: 518-813-0317
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberP134680
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: