Provider Demographics
NPI:1487748299
Name:KAPPENBERG, CATHERINE FAITH (LCSW)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:FAITH
Last Name:KAPPENBERG
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 1:6 SPRUCE PL STE 5
Mailing Address - Street 2:
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-1104
Mailing Address - Country:US
Mailing Address - Phone:516-242-4341
Mailing Address - Fax:516-407-5544
Practice Address - Street 1:6 SPRUCE PL STE 5
Practice Address - Street 2:
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747-1104
Practice Address - Country:US
Practice Address - Phone:516-242-4341
Practice Address - Fax:516-407-5544
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR012542-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN41361Medicare ID - Type UnspecifiedCLINICAL SOCIAL WORKER