Provider Demographics
NPI:1710219068
Name:DEMAIO, KATHLEEN (LCSW; LCADC)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:DEMAIO
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 1:301 ROUTE 9 SOUTH
Mailing Address - Street 2:
Mailing Address - City:MANALAPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726
Mailing Address - Country:US
Mailing Address - Phone:908-907-7530
Mailing Address - Fax:732-972-0476
Practice Address - Street 1:301 ROUTE 9 SOUTH
Practice Address - Street 2:
Practice Address - City:MANALAPAN
Practice Address - State:NJ
Practice Address - Zip Code:07726
Practice Address - Country:US
Practice Address - Phone:908-907-7530
Practice Address - Fax:732-972-0476
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-10
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00174200101YA0400X
NJ44SC054113001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)