Healthcare Provider Details

I. General information

NPI: 1043357858
Provider Name (Legal Business Name): KATHERINE ANNE PORTERFIELD PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

462 1ST AVE CD 710, PSOT
NEW YORK NY
10016-9196
US

IV. Provider business mailing address

591 10TH ST # 1
BROOKLYN NY
11215-4401
US

V. Phone/Fax

Practice location:
  • Phone: 212-994-7163
  • Fax: 212-994-7177
Mailing address:
  • Phone: 212-994-7163
  • Fax: 212-994-7177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0141051
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: