Healthcare Provider Details

I. General information

NPI: 1023762135
Provider Name (Legal Business Name): KASMONE WILLIAMS CAT-LP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2022
Last Update Date: 02/08/2022
Certification Date: 10/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 SYLVIA ST
STATEN ISLAND NY
10312-3723
US

IV. Provider business mailing address

2305 2ND AVE APT 25
NEW YORK NY
10035-4115
US

V. Phone/Fax

Practice location:
  • Phone: 254-392-3847
  • Fax:
Mailing address:
  • Phone: 254-392-3847
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number113769
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: