Healthcare Provider Details

I. General information

NPI: 1578652970
Provider Name (Legal Business Name): KATHLEEN A DEMERS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 YALE DR
SUFFERN NY
10901-7401
US

IV. Provider business mailing address

9 YALE DR
SUFFERN NY
10901-7401
US

V. Phone/Fax

Practice location:
  • Phone: 845-357-3712
  • Fax:
Mailing address:
  • Phone: 845-357-3712
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC04507800
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: