Most Relevant Information
Provider Data
| NPI Number: | 1003339508 |
| Provider Name: | KATHERINE MICETICH LMSW |
| Entity Type: | Individual |
| Taxonomy Code: | 174400000X |
| Specialty: | Specialist |
| License Number: |
Most Important Dates
| Enumeration Date: | 07/18/2017 |
| Last Updated: | 07/18/2017 |
Provider Practice Location
329 E 149TH ST FL 4
BRONX
NY
104515626
Practice Location Phone/Fax
| Phone: | 7187692698 |
| Fax: |
Provider Mailing Location
3855 ORLOFF AVE APT LA
BRONX
NY
104632610
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |