Provider Demographics
NPI:1427756899
Name:DAWYBIDA, CATHERINE ELLEN
Entity type:Individual
Prefix:MRS
First Name:CATHERINE
Middle Name:ELLEN
Last Name:DAWYBIDA
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:CATHERINE
Other - Middle Name:ELLEN
Other - Last Name:MONTEMARANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5 HERRINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:EAST GREENBUSH
Mailing Address - State:NY
Mailing Address - Zip Code:12061-1518
Mailing Address - Country:US
Mailing Address - Phone:917-374-9788
Mailing Address - Fax:
Practice Address - Street 1:32 COHOES RD
Practice Address - Street 2:
Practice Address - City:WATERVLIET
Practice Address - State:NY
Practice Address - Zip Code:12189-1811
Practice Address - Country:US
Practice Address - Phone:917-374-9788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-15
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY261QD1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities