Provider Demographics
NPI:1528624624
Name:SILIRIS, KATARINA
Entity type:Individual
Prefix:
First Name:KATARINA
Middle Name:
Last Name:SILIRIS
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 1:208 N OCEAN AVE
Mailing Address - Street 2:
Mailing Address - City:PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-2006
Mailing Address - Country:US
Mailing Address - Phone:631-268-0769
Mailing Address - Fax:
Practice Address - Street 1:208 N OCEAN AVE
Practice Address - Street 2:
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-2006
Practice Address - Country:US
Practice Address - Phone:631-268-0769
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-14
Last Update Date:2023-06-07
Deactivation Date:2023-05-11
Deactivation Code:
Reactivation Date:2023-06-01
Provider Licenses
StateLicense IDTaxonomies
NY0953291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical