Provider Demographics
NPI:1750669867
Name:DIMUZIO, KATHLEEN HARIETT (LCSW, LICSW)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:HARIETT
Last Name:DIMUZIO
Suffix:
Gender:F
Credentials:LCSW, LICSW
Other - Prefix:MS
Other - First Name:KATHLEEN
Other - Middle Name:HARIETT
Other - Last Name:MORAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:9615 SHORE RD APT 2G
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-7619
Mailing Address - Country:US
Mailing Address - Phone:332-333-2448
Mailing Address - Fax:
Practice Address - Street 1:9615 SHORE RD APT 2G
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-7619
Practice Address - Country:US
Practice Address - Phone:332-333-2448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-25
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040094701041C0700X
DCLC500814511041C0700X
NY0811971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical