=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134610850
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CATHERINE MCDERMOTT-COFFIN PSYD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/29/2018
-----------------------------------------------------
Last Update Date | 05/29/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 110 WOOD RD
-----------------------------------------------------
City | BEDFORD HILLS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10507-1205
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-244-1656
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 110 WOOD RD
-----------------------------------------------------
City | BEDFORD HILLS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10507-1205
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-244-1656
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 016459
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | 016459
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------