=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710674874
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | APRIL MEREDITH TETTEMER LCAT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/19/2023
-----------------------------------------------------
Last Update Date | 04/19/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2024 WILLIAMSBRIDGE RD STE 3
-----------------------------------------------------
City | BRONX
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10461-1631
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-992-1569
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 332 E 95TH ST APT 21
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10128-5729
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-242-0761
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 221700000X
-----------------------------------------------------
Taxonomy Name | Art Therapist
-----------------------------------------------------
License Number | 002790
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------