Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 15887 | NY |
Y | 103T00000X | Psychologist | 15887 | NY |
NPI | 1013046648 |
---|---|
Provider Name | Katherine Burdick |
First Address | Glen Oaks, NY 11004 |
Second Address | Glen Oaks, NY 11004 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/03/2007 |
Last Update Date | 08/07/2007 |