Provider Demographics
NPI:1659120350
Name:TATE, KIAH N (LMSW)
Entity type:Individual
Prefix:MS
First Name:KIAH
Middle Name:N
Last Name:TATE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1536 VYSE AVE APT 5C
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10460-5601
Mailing Address - Country:US
Mailing Address - Phone:347-841-2008
Mailing Address - Fax:
Practice Address - Street 1:4624 BROADWAY
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10040-2102
Practice Address - Country:US
Practice Address - Phone:212-569-1044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-15
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY123268104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker