Provider Demographics
NPI:1104517317
Name:RESTIFO, KATHLEEN (PHD)
Entity type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:
Last Name:RESTIFO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:GARDELAAN 16
Mailing Address - Street 2:
Mailing Address - City:MAASTRICHT
Mailing Address - State:LIMBURG
Mailing Address - Zip Code:6213CV
Mailing Address - Country:NL
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:111 E 77TH ST STE 3
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075-1802
Practice Address - Country:US
Practice Address - Phone:212-434-2961
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-18
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013384103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY013384OtherNEW YORK STATE EDUCATION DEPARTMENT