Provider Demographics
NPI:1306235734
Name:REDDICK, CATRICE (NA)
Entity type:Individual
Prefix:
First Name:CATRICE
Middle Name:
Last Name:REDDICK
Suffix:
Gender:F
Credentials:NA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 JUDITH DR
Mailing Address - Street 2:
Mailing Address - City:CORAM
Mailing Address - State:NY
Mailing Address - Zip Code:11727-4024
Mailing Address - Country:US
Mailing Address - Phone:631-525-0044
Mailing Address - Fax:
Practice Address - Street 1:21 JUDITH DR
Practice Address - Street 2:
Practice Address - City:CORAM
Practice Address - State:NY
Practice Address - Zip Code:11727-4024
Practice Address - Country:US
Practice Address - Phone:631-525-0044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-22
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY342658630308E376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide