Healthcare Provider Details

I. General information

NPI: 1194551960
Provider Name (Legal Business Name): KATHERINE BARNEY-PEZZOLA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2024
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 JENSEN AVE
MAMARONECK NY
10543-2930
US

IV. Provider business mailing address

225 JENSEN AVE
MAMARONECK NY
10543-2930
US

V. Phone/Fax

Practice location:
  • Phone: 914-414-5739
  • Fax:
Mailing address:
  • Phone: 914-361-9005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number001321-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number1792
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: