Provider Demographics
NPI:1205343324
Name:MCCOOE, KATHERINE (LAC)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:MCCOOE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:
Other - Last Name:PICON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:26 WILLOW CT
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08619-4621
Mailing Address - Country:US
Mailing Address - Phone:908-566-5470
Mailing Address - Fax:
Practice Address - Street 1:4065 QUAKERBRIDGE RD
Practice Address - Street 2:
Practice Address - City:PRINCETON JUNCTION
Practice Address - State:NJ
Practice Address - Zip Code:08550-5243
Practice Address - Country:US
Practice Address - Phone:609-651-4001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-10
Last Update Date:2018-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00391400101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health