Healthcare Provider Details

I. General information

NPI: 1679485890
Provider Name (Legal Business Name): KATHRYN MARDELE WEBER NCSP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1835 N CENTRAL AVE
VALLEY STREAM NY
11580-1034
US

IV. Provider business mailing address

37 PARKVIEW PL
BALDWIN NY
11510-3445
US

V. Phone/Fax

Practice location:
  • Phone: 516-285-8310
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: