Provider Demographics
NPI:1891393666
Name:DE VITO, KATHERINE I
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:I
Last Name:DE VITO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:226 SAINT PAUL ST # 2D
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07090-2100
Mailing Address - Country:US
Mailing Address - Phone:908-913-7655
Mailing Address - Fax:
Practice Address - Street 1:226 SAINT PAUL ST APT 2D
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07090-2100
Practice Address - Country:US
Practice Address - Phone:908-913-7655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-14
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC053138001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical