Provider Demographics
NPI:1043522998
Name:KAJETZKE, CHRISTINE (LCSW)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:KAJETZKE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 15TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-4988
Mailing Address - Country:US
Mailing Address - Phone:718-788-5101
Mailing Address - Fax:718-788-5102
Practice Address - Street 1:255 15TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-4988
Practice Address - Country:US
Practice Address - Phone:718-788-5101
Practice Address - Fax:718-788-5102
Is Sole Proprietor?:No
Enumeration Date:2010-07-08
Last Update Date:2015-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0810761041C0700X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical