Healthcare Provider Details

I. General information

NPI: 1124231832
Provider Name (Legal Business Name): MARIA KUETHE PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 03/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 CENTRAL AVE
ALBANY NY
12210-1334
US

IV. Provider business mailing address

4 CENTRAL AVE
ALBANY NY
12210-1334
US

V. Phone/Fax

Practice location:
  • Phone: 800-275-3243
  • Fax: 800-275-3671
Mailing address:
  • Phone: 800-275-3243
  • Fax: 800-275-3671

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number009700-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: