Katelyn M Kidwell, MA, RDT ,LCAT

Primary specialty

Drama TherapistTaxonomy code 101200000X

License

002670-01 Issued in NY

Practice address

680 Bloomfield Ave Apt 2
Bloomfield, NJ 07003-4352

Phone

(862) 283-0386

NPI assigned

Jan 11, 2024

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1704931200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1704931200000",
    "number": "1770354359",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "680 BLOOMFIELD AVE APT 2",
            "city": "BLOOMFIELD",
            "state": "NJ",
            "postal_code": "070034352",
            "telephone_number": "862-283-0386"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "680 BLOOMFIELD AVE APT 2",
            "city": "BLOOMFIELD",
            "state": "NJ",
            "postal_code": "070034352",
            "telephone_number": "862-283-0386"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "57 W 57th St Ste 1101",
            "address_purpose": "LOCATION",
            "city": "New York",
            "state": "NY",
            "postal_code": "100192814",
            "country_code": "US",
            "telephone_number": "866-525-2766",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KIDWELL",
        "first_name": "KATELYN",
        "middle_name": "M",
        "name_prefix": "Mrs.",
        "credential": "MA, RDT ,LCAT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-01-11",
        "last_updated": "2024-01-11",
        "certification_date": "2024-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101200000X",
            "taxonomy_group": "",
            "desc": "Drama Therapist",
            "state": "NY",
            "license": "002670-01",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Drama Therapist in Bloomfield, NJ
• Providers in Bloomfield, NJ by specialty
• Drama Therapist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.