Provider Demographics
NPI:1760759013
Name:CONIGLIARO, KATHY ANN (BA ED)
Entity Type:Individual
Prefix:MS
First Name:KATHY
Middle Name:ANN
Last Name:CONIGLIARO
Suffix:
Gender:F
Credentials:BA ED
Other - Prefix:MS
Other - First Name:KATHY
Other - Middle Name:ANN
Other - Last Name:FREDERICKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA ED
Mailing Address - Street 1:325 HERBERTSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724-1713
Mailing Address - Country:US
Mailing Address - Phone:732-836-3322
Mailing Address - Fax:732-840-0965
Practice Address - Street 1:325 HERBERTSVILLE RD
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724-1713
Practice Address - Country:US
Practice Address - Phone:732-836-3322
Practice Address - Fax:732-840-0965
Is Sole Proprietor?:No
Enumeration Date:2011-11-30
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ09101910101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor