Provider Demographics
NPI:1568730687
Name:MEMOLI, KATHRYN AGNES (MSW)
Entity Type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:AGNES
Last Name:MEMOLI
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MS
Other - First Name:KATE
Other - Middle Name:
Other - Last Name:MEMOLI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:200 ATLANTIC AVE
Mailing Address - Street 2:SUITE K
Mailing Address - City:MANASQUAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08736-1352
Mailing Address - Country:US
Mailing Address - Phone:732-292-0388
Mailing Address - Fax:732-292-0399
Practice Address - Street 1:200 ATLANTIC AVE
Practice Address - Street 2:SUITE K
Practice Address - City:MANASQUAN
Practice Address - State:NJ
Practice Address - Zip Code:08736-1352
Practice Address - Country:US
Practice Address - Phone:732-292-0388
Practice Address - Fax:732-292-0399
Is Sole Proprietor?:No
Enumeration Date:2011-12-03
Last Update Date:2011-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC003970001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical