Provider Demographics
NPI:1215526702
Name:HAMDAN, KATHERINE A (MA)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:A
Last Name:HAMDAN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:A
Other - Last Name:LIVI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:157 JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:AMITYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11701-2325
Mailing Address - Country:US
Mailing Address - Phone:423-507-7910
Mailing Address - Fax:
Practice Address - Street 1:157 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:AMITYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11701-2325
Practice Address - Country:US
Practice Address - Phone:423-507-7910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-11
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010826101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health