Healthcare Provider Details

I. General information

NPI: 1295543445
Provider Name (Legal Business Name): KATHERINE GUREVICH MSW, CASAC LEVEL 2
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2024
Last Update Date: 12/19/2024
Certification Date: 12/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16110 JAMAICA AVE
JAMAICA NY
11432-6139
US

IV. Provider business mailing address

2044 21ST DR APT 4G
BROOKLYN NY
11214-6357
US

V. Phone/Fax

Practice location:
  • Phone: 718-674-1000
  • Fax:
Mailing address:
  • Phone: 929-400-1826
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number39817
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: