Healthcare Provider Details

I. General information

NPI: 1285334672
Provider Name (Legal Business Name): KATE POWERS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2023
Last Update Date: 03/06/2023
Certification Date: 03/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 SOUTH RD
BROOKTONDALE NY
14817-9721
US

IV. Provider business mailing address

1267 ELMIRA RD
NEWFIELD NY
14867-9280
US

V. Phone/Fax

Practice location:
  • Phone: 607-391-1300
  • Fax:
Mailing address:
  • Phone: 607-592-9790
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberP120460
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: