Provider Demographics
NPI:1093863847
Name:MATHEWS, KATHLEEN J (LCSW)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:J
Last Name:MATHEWS
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 1:733 E ROUTE 70
Mailing Address - Street 2:SUITE 406
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-2300
Mailing Address - Country:US
Mailing Address - Phone:609-519-0804
Mailing Address - Fax:
Practice Address - Street 1:733 E ROUTE 70
Practice Address - Street 2:SUITE 406
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-2300
Practice Address - Country:US
Practice Address - Phone:609-519-0804
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC048526001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical