Provider Demographics
NPI:1639233984
Name:GEBHARDT, KATHLEEN (MSW, LCSW,BCD)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:
Last Name:GEBHARDT
Suffix:
Gender:F
Credentials:MSW, LCSW,BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 CARTERET ST
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07043-1304
Mailing Address - Country:US
Mailing Address - Phone:973-744-2395
Mailing Address - Fax:973-655-9174
Practice Address - Street 1:28 CARTERET ST
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07043-1304
Practice Address - Country:US
Practice Address - Phone:973-744-2395
Practice Address - Fax:973-655-9174
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC000248001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical