Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC2200X | Clinical Child & Adolescent Psychologist |
NPI | 1013409416 |
---|---|
Provider Name | Katherine Lou Durham |
First Address | New York, NY 10040-1919 |
Second Address | White Plains, NY 10605-1201 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2018 |
Last Update Date | 31/05/2018 |