Provider Demographics
NPI:1801222617
Name:WAEHLER, KATHLEEN MARIE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:MARIE
Last Name:WAEHLER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:298 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:WESTWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07675-1904
Mailing Address - Country:US
Mailing Address - Phone:973-600-5273
Mailing Address - Fax:
Practice Address - Street 1:192 THIRD AVENUE - SUITES 3 & 4
Practice Address - Street 2:
Practice Address - City:WESTWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07675-1904
Practice Address - Country:US
Practice Address - Phone:201-666-2402
Practice Address - Fax:201-666-2472
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-25
Last Update Date:2013-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC054699001041C0700X
NJ8649071041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool