MEDICARE: KATHRYN FLORINE STALEY L.P.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TP0814X	Psychoanalysis Psychologist	000922	NY

General Provider Information

NPI Number	:	1629844071
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHRYN FLORINE STALEY L.P.

Provider Business Mailing Address
First Line	:	47 E 88TH ST APT 15B
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10128-1152
Country	:	US
Telephone Number	:	631-457-9249
Fax Number	:

Provider Business Practice Location Address
First Line	:	47 E 88TH ST APT 15B
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10128-1152
Country	:	US
Telephone Number	:	631-457-9249
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/28/2023
Last Update Date	:	11/28/2023

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