Provider Demographics
NPI:1699210559
Name:BUZZONE-BROOKS, KATHLEEN P (MSW, LSW)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:P
Last Name:BUZZONE-BROOKS
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 VICTORIAN WOODS DR
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC HIGHLANDS
Mailing Address - State:NJ
Mailing Address - Zip Code:07716-1500
Mailing Address - Country:US
Mailing Address - Phone:732-240-2545
Mailing Address - Fax:732-475-6265
Practice Address - Street 1:522 BRICK BLVD
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08723-6089
Practice Address - Country:US
Practice Address - Phone:732-240-2545
Practice Address - Fax:732-475-6265
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-03
Last Update Date:2017-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06237500104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker