Provider Demographics
NPI:1710503578
Name:GAETANO, DENISE (LSW)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:GAETANO
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39A SUNSET RD
Mailing Address - Street 2:
Mailing Address - City:WHITING
Mailing Address - State:NJ
Mailing Address - Zip Code:08759-2040
Mailing Address - Country:US
Mailing Address - Phone:732-644-9523
Mailing Address - Fax:
Practice Address - Street 1:39A SUNSET RD
Practice Address - Street 2:
Practice Address - City:WHITING
Practice Address - State:NJ
Practice Address - Zip Code:08759-2040
Practice Address - Country:US
Practice Address - Phone:732-644-9523
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-17
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL05691100104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker