Healthcare Provider Details

I. General information

NPI: 1073599064
Provider Name (Legal Business Name): KATHARIYA MOKRUE PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2005
Last Update Date: 10/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 EAST 55TH STREET SUITE 3A
NEW YORK NY
10022
US

IV. Provider business mailing address

141 EAST 55TH STREET SUITE 3A
NEW YORK NY
10022
US

V. Phone/Fax

Practice location:
  • Phone: 347-735-9881
  • Fax:
Mailing address:
  • Phone: 347-735-9881
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number016075-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: