Provider Demographics
NPI:1639225881
Name:CAPAWANA, KATHRYN (LCSW, LCADC)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:CAPAWANA
Suffix:
Gender:F
Credentials:LCSW, LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:645 WESTWOOD AVE
Mailing Address - Street 2:STE 204
Mailing Address - City:RIVER VALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07675-5300
Mailing Address - Country:US
Mailing Address - Phone:201-895-6402
Mailing Address - Fax:
Practice Address - Street 1:645 WESTWOOD AVENUE
Practice Address - Street 2:SUITE 204
Practice Address - City:RIVERVALE
Practice Address - State:NJ
Practice Address - Zip Code:07675-6295
Practice Address - Country:US
Practice Address - Phone:201-895-6402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-27
Last Update Date:2019-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNJLCADC37LC00126400101YA0400X
NJNJLCSW44SC05188001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)