Provider Demographics
NPI:1063930865
Name:GOLDTHWAIT, CATHY ANN
Entity type:Individual
Prefix:
First Name:CATHY
Middle Name:ANN
Last Name:GOLDTHWAIT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:518 JAMES ST
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13203-2238
Mailing Address - Country:US
Mailing Address - Phone:315-478-2453
Mailing Address - Fax:315-427-8917
Practice Address - Street 1:375 W ONONDAGA ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13202-1888
Practice Address - Country:US
Practice Address - Phone:315-478-2030
Practice Address - Fax:315-478-2250
Is Sole Proprietor?:No
Enumeration Date:2017-09-01
Last Update Date:2017-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1508898321Medicaid