Healthcare Provider Details

I. General information

NPI: 1902787104
Provider Name (Legal Business Name): KATELYN ELIZABETH LITWAK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2025
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 PARK AVE
SCHENECTADY NY
12304-1628
US

IV. Provider business mailing address

60 ACADEMY RD
ALBANY NY
12208-3103
US

V. Phone/Fax

Practice location:
  • Phone: 518-813-0317
  • Fax:
Mailing address:
  • Phone: 518-813-0317
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number132636
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: