Provider Demographics
NPI:1689137275
Name:MCGLASHAN, KAVELLE TRICIA (BA, CADC INTERN)
Entity Type:Individual
Prefix:
First Name:KAVELLE
Middle Name:TRICIA
Last Name:MCGLASHAN
Suffix:
Gender:F
Credentials:BA, CADC INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:293 KINDERKAMACK RD APT B
Mailing Address - Street 2:
Mailing Address - City:RIVER EDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07661-1879
Mailing Address - Country:US
Mailing Address - Phone:201-888-5396
Mailing Address - Fax:
Practice Address - Street 1:93 W PALISADE AVE
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-2611
Practice Address - Country:US
Practice Address - Phone:201-567-0500
Practice Address - Fax:201-567-9335
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-10
Last Update Date:2019-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)