Provider Demographics
NPI:1053669044
Name:DIVIAIO, KATHERINE BERGEN (LCSW)
Entity type:Individual
Prefix:MISS
First Name:KATHERINE
Middle Name:BERGEN
Last Name:DIVIAIO
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 BIRCHWOOD KNLS
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08648-3610
Mailing Address - Country:US
Mailing Address - Phone:908-872-3805
Mailing Address - Fax:609-430-4898
Practice Address - Street 1:3635 QUAKERBRIDGE RD STE 11
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08619-1247
Practice Address - Country:US
Practice Address - Phone:609-285-3889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-22
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC056512001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical