Healthcare Provider Details

I. General information

NPI: 1710349030
Provider Name (Legal Business Name): KATHERINE WARDEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2016
Last Update Date: 05/26/2021
Certification Date: 05/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 HOBART ST
UTICA NY
13501-4308
US

IV. Provider business mailing address

120 HOBART ST
UTICA NY
13501-4308
US

V. Phone/Fax

Practice location:
  • Phone: 315-801-3583
  • Fax:
Mailing address:
  • Phone: 315-801-3583
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number020856
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: