Provider Demographics
NPI:1467489534
Name:KANE, KATE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:KATE
Middle Name:
Last Name:KANE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 PROSPECT RD
Mailing Address - Street 2:
Mailing Address - City:CENTERPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11721-1149
Mailing Address - Country:US
Mailing Address - Phone:631-239-5522
Mailing Address - Fax:
Practice Address - Street 1:203 PROSPECT RD
Practice Address - Street 2:
Practice Address - City:CENTERPORT
Practice Address - State:NY
Practice Address - Zip Code:11721-1149
Practice Address - Country:US
Practice Address - Phone:631-239-5522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR0095421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY7402992OtherGHI
NYN17631Medicare ID - Type UnspecifiedMEDICARE