Provider Demographics
NPI:1053669044
Name:TEIXEIRA, KATHERINE BERGEN (LCSW)
Entity Type:Individual
Prefix:MISS
First Name:KATHERINE
Middle Name:BERGEN
Last Name:TEIXEIRA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1000 HERRONTOWN RD
Mailing Address - Street 2:2ND STORY BUILDING
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-7716
Mailing Address - Country:US
Mailing Address - Phone:609-613-4753
Mailing Address - Fax:609-430-4898
Practice Address - Street 1:1000 HERRONTOWN RD
Practice Address - Street 2:2ND STORY BUILDING
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-7716
Practice Address - Country:US
Practice Address - Phone:609-613-4753
Practice Address - Fax:609-430-4898
Is Sole Proprietor?:No
Enumeration Date:2012-08-22
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC056512001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical