Provider Demographics
NPI:1902188915
Name:KATHRYN CAPAWANA, LCSW, LCADC, LLC
Entity Type:Organization
Organization Name:KATHRYN CAPAWANA, LCSW, LCADC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:
Authorized Official - Last Name:CAPAWANA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, LCADC
Authorized Official - Phone:201-895-6402
Mailing Address - Street 1:645 WESTWOOD AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:RIVERVALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07675-6295
Mailing Address - Country:US
Mailing Address - Phone:201-895-6402
Mailing Address - Fax:201-358-1386
Practice Address - Street 1:645 WESTWOOD AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:RIVERVALE
Practice Address - State:NJ
Practice Address - Zip Code:07675-6295
Practice Address - Country:US
Practice Address - Phone:201-895-6402
Practice Address - Fax:201-358-1386
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-15
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC051588001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ096928Medicare PIN