Healthcare Provider Details

I. General information

NPI: 1821141755
Provider Name (Legal Business Name): CATHERINE A PUTKOWSKI-O'BRIEN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 11/14/2021
Certification Date: 11/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2336 RICHMOND RD
STATEN ISLAND NY
10306-2346
US

IV. Provider business mailing address

PO BOX 140440
STATEN ISLAND NY
10314-0440
US

V. Phone/Fax

Practice location:
  • Phone: 718-351-3030
  • Fax: 718-442-6940
Mailing address:
  • Phone: 917-885-8967
  • Fax: 718-273-3245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR028848-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: