Provider Demographics
NPI:1295921971
Name:KABAT, MARY (MSW)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:
Last Name:KABAT
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 FAIRVIEW AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:VERONA
Mailing Address - State:NJ
Mailing Address - Zip Code:07044-1318
Mailing Address - Country:US
Mailing Address - Phone:973-243-4994
Mailing Address - Fax:973-400-4131
Practice Address - Street 1:110 FAIRVIEW AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:VERONA
Practice Address - State:NJ
Practice Address - Zip Code:07044-1318
Practice Address - Country:US
Practice Address - Phone:973-243-4994
Practice Address - Fax:973-400-4131
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-17
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC004806001041C0700X
NJ37FI00141600106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ150620Medicare PIN