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General NPI Number Information
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NPI Number | 1649832445
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Entity Type | Individual
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Provider Name | KATHLEEN LOUISE NIEGOCKI PH.D.
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Gender | Female
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Dates
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Enumeration Date | 07/01/2019
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Last Update Date | 07/01/2019
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Provider Practice Location Address
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Address Line | 240 W 102ND ST APT 15
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City | NEW YORK
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State | NY
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Zip | 10025-4924
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Country | US
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Telephone | 929-265-2558
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Fax |
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Provider Business Mailing Address
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Address Line | 780 RIVERSIDE DR APT 6FF
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City | NEW YORK
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State | NY
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Zip | 10032-0397
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Country | US
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Telephone | 917-697-2296
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | 021506
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License Number State | NY
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