Provider Demographics
NPI:1821275058
Name:KANE, MARY CLARE (LMFT)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:CLARE
Last Name:KANE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 ROBIN ST
Mailing Address - Street 2:
Mailing Address - City:ROCKAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:07866-2309
Mailing Address - Country:US
Mailing Address - Phone:973-625-8711
Mailing Address - Fax:
Practice Address - Street 1:17 ROBIN ST
Practice Address - Street 2:
Practice Address - City:ROCKAWAY
Practice Address - State:NJ
Practice Address - Zip Code:07866-2309
Practice Address - Country:US
Practice Address - Phone:973-625-8711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-30
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37FL00133700106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ37FL00133700OtherMARRIAGE/FAMILY THERAPIST