Provider Demographics
NPI:1356779011
Name:TANIS, CATHERINE DOROTHY (LCSW)
Entity type:Individual
Prefix:MRS
First Name:CATHERINE
Middle Name:DOROTHY
Last Name:TANIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 RAVINE AVE
Mailing Address - Street 2:
Mailing Address - City:WYCKOFF
Mailing Address - State:NJ
Mailing Address - Zip Code:07481-2919
Mailing Address - Country:US
Mailing Address - Phone:201-390-9107
Mailing Address - Fax:201-612-0177
Practice Address - Street 1:311 CLAREMONT AVE
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-2240
Practice Address - Country:US
Practice Address - Phone:201-468-1863
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-16
Last Update Date:2013-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC054628001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical