Provider Demographics
NPI:1225626328
Name:DRAKE, KATHERINE (LAMFT)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:DRAKE
Suffix:
Gender:F
Credentials:LAMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98 PALMER LN
Mailing Address - Street 2:
Mailing Address - City:EWING
Mailing Address - State:NJ
Mailing Address - Zip Code:08618-3206
Mailing Address - Country:US
Mailing Address - Phone:862-268-2409
Mailing Address - Fax:
Practice Address - Street 1:1 VANDERVEER DR
Practice Address - Street 2:
Practice Address - City:LAWRENCE TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08648-3113
Practice Address - Country:US
Practice Address - Phone:609-647-0714
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-05
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37FA00019400106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ37FA00019400OtherNEW JERSEY DIVISION OF CONSUMER AFFAIRS