Healthcare Provider Details

I. General information

NPI: 1588391692
Provider Name (Legal Business Name): KATARINA MYERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2022
Last Update Date: 06/11/2025
Certification Date: 06/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7767 OSWEGO RD
LIVERPOOL NY
13090-2322
US

IV. Provider business mailing address

7767 OSWEGO RD
LIVERPOOL NY
13090-2322
US

V. Phone/Fax

Practice location:
  • Phone: 315-992-1929
  • Fax:
Mailing address:
  • Phone: 718-215-5311
  • Fax: 718-865-5165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number003181
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: