Provider Demographics
NPI:1114066370
Name:SPEISER, KATHERINE (EDS)
Entity Type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:
Last Name:SPEISER
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 REDMAN TER
Mailing Address - Street 2:
Mailing Address - City:WEST CALDWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07006-7924
Mailing Address - Country:US
Mailing Address - Phone:973-403-1949
Mailing Address - Fax:
Practice Address - Street 1:51 REDMAN TER
Practice Address - Street 2:
Practice Address - City:WEST CALDWELL
Practice Address - State:NJ
Practice Address - Zip Code:07006-7924
Practice Address - Country:US
Practice Address - Phone:973-403-1949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37F100157400106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist