Healthcare Provider Details

I. General information

NPI: 1154188704
Provider Name (Legal Business Name): CATHERINE MYKYTIUK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/29/2024
Last Update Date: 02/29/2024
Certification Date: 02/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3101 KINGSBRIDGE TER
BRONX NY
10463-5900
US

IV. Provider business mailing address

536 FORT WASHINGTON AVE APT 5H
NEW YORK NY
10033-2025
US

V. Phone/Fax

Practice location:
  • Phone: 718-884-0700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number091977
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: