Provider Demographics
NPI:1265945372
Name:MANN, KATHLEEN (LAC/LCADC, CCS)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:MANN
Suffix:
Gender:F
Credentials:LAC/LCADC, CCS
Other - Prefix:
Other - First Name:KATHY
Other - Middle Name:
Other - Last Name:MANN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:625 LAUREL RD
Mailing Address - Street 2:
Mailing Address - City:OCEAN CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08226-4538
Mailing Address - Country:US
Mailing Address - Phone:609-846-4275
Mailing Address - Fax:
Practice Address - Street 1:625 LAUREL RD
Practice Address - Street 2:
Practice Address - City:OCEAN CITY
Practice Address - State:NJ
Practice Address - Zip Code:08226-4538
Practice Address - Country:US
Practice Address - Phone:609-846-4275
Practice Address - Fax:609-846-4275
Is Sole Proprietor?:No
Enumeration Date:2017-11-10
Last Update Date:2023-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X, 101YM0800X
NJ37AC00353500101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ37AC00353500Medicaid
NJ37AC00353500OtherN/A