Provider Demographics
NPI:1306233598
Name:MICHAELS, CATHERINE BAUER (PSYD)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:BAUER
Last Name:MICHAELS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 NEW LOUDON RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-2100
Mailing Address - Country:US
Mailing Address - Phone:518-608-4271
Mailing Address - Fax:518-608-4269
Practice Address - Street 1:950 NEW LOUDON RD
Practice Address - Street 2:SUITE 101
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-2100
Practice Address - Country:US
Practice Address - Phone:518-608-4271
Practice Address - Fax:518-608-4269
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-25
Last Update Date:2015-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020996-1103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist