Provider Demographics
NPI:1154036267
Name:ACOMPORA, KATIE LYNN
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:LYNN
Last Name:ACOMPORA
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 1:10 PEARL ST FL 2
Mailing Address - Street 2:
Mailing Address - City:PORT CHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:10573-4611
Mailing Address - Country:US
Mailing Address - Phone:276-291-4265
Mailing Address - Fax:
Practice Address - Street 1:444 E BOSTON POST RD
Practice Address - Street 2:
Practice Address - City:MAMARONECK
Practice Address - State:NY
Practice Address - Zip Code:10543-3708
Practice Address - Country:US
Practice Address - Phone:914-236-5097
Practice Address - Fax:347-348-0678
Is Sole Proprietor?:No
Enumeration Date:2023-01-23
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY18-P117279-02101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor