Provider Demographics
NPI:1265776819
Name:FRADE, TANJA KATICA (MSW, LCSW)
Entity type:Individual
Prefix:MRS
First Name:TANJA
Middle Name:KATICA
Last Name:FRADE
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 CHESTNUT TER
Mailing Address - Street 2:
Mailing Address - City:ROCKAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:07866-2429
Mailing Address - Country:US
Mailing Address - Phone:908-229-3138
Mailing Address - Fax:
Practice Address - Street 1:5 REGENT ST BLDG 5S
Practice Address - Street 2:SUITE 518
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-1675
Practice Address - Country:US
Practice Address - Phone:908-229-3138
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-20
Last Update Date:2013-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC055064001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical