Provider Demographics
NPI:1699947069
Name:CATTICH, JOHN F (PHD,, MS, MDIV,)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:F
Last Name:CATTICH
Suffix:
Gender:M
Credentials:PHD,, MS, MDIV,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 SNYDER CIR
Mailing Address - Street 2:
Mailing Address - City:STONE RIDGE
Mailing Address - State:NY
Mailing Address - Zip Code:12484-5507
Mailing Address - Country:US
Mailing Address - Phone:704-682-7108
Mailing Address - Fax:
Practice Address - Street 1:22 SNYDER CIR
Practice Address - Street 2:
Practice Address - City:STONE RIDGE
Practice Address - State:NY
Practice Address - Zip Code:12484-5507
Practice Address - Country:US
Practice Address - Phone:704-682-7108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-26
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY961106H00000X
NC1221106H00000X
TX201789106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist