Healthcare Provider Details

I. General information

NPI: 1780085514
Provider Name (Legal Business Name): KATE GUDIMENKO LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2014
Last Update Date: 09/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5800 3RD AVE
BROOKLYN NY
11220-3702
US

IV. Provider business mailing address

5800 3RD AVE
BROOKLYN NY
11220-3702
US

V. Phone/Fax

Practice location:
  • Phone: 718-630-8298
  • Fax: 718-630-7437
Mailing address:
  • Phone: 718-630-8298
  • Fax: 718-630-7437

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number092193
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: