Provider Demographics
NPI:1962011759
Name:SAMMIS, KATHERINE RUSSELL (MS, MHC-LP)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:RUSSELL
Last Name:SAMMIS
Suffix:
Gender:F
Credentials:MS, MHC-LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 E 89TH ST APT 3E
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-2306
Mailing Address - Country:US
Mailing Address - Phone:484-369-1819
Mailing Address - Fax:
Practice Address - Street 1:1441 BROADWAY FL 5
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10018-1905
Practice Address - Country:US
Practice Address - Phone:646-842-1580
Practice Address - Fax:646-844-7585
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-28
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health