1639264542 NPI number — PAULETTE KITAEFF LCSWR

Table of content: (NPI 1073992509)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639264542 NPI number — PAULETTE KITAEFF LCSWR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KITAEFF
Provider First Name:
PAULETTE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSWR
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1639264542
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
98120 QUEENS BLVD
Provider Second Line Business Mailing Address:
APT 1C
Provider Business Mailing Address City Name:
REGO PARK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11374
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-830-0246
Provider Business Mailing Address Fax Number:
718-830-9088

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 WOODBURY RD
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
WOODBURY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11797
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-594-0247
Provider Business Practice Location Address Fax Number:
718-830-9088
Provider Enumeration Date:
10/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X , with the licence number:  0211291 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7408197 . This is a "GHI" identifier . This identifiers is of the category "OTHER".
  • Identifier: P928290 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".




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