Provider Demographics
NPI:1386153930
Name:KATUSHA, KIMBERLEE
Entity type:Individual
Prefix:
First Name:KIMBERLEE
Middle Name:
Last Name:KATUSHA
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 1:5 COURT ST STE 42
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:NY
Mailing Address - Zip Code:13815-1695
Mailing Address - Country:US
Mailing Address - Phone:607-337-1600
Mailing Address - Fax:607-334-4519
Practice Address - Street 1:5 COURT ST STE 42
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:NY
Practice Address - Zip Code:13815-1695
Practice Address - Country:US
Practice Address - Phone:607-331-6007
Practice Address - Fax:607-334-4519
Is Sole Proprietor?:No
Enumeration Date:2017-09-27
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY091482-011041C0700X
NY101115-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical