Provider Demographics
NPI:1881794907
Name:FIKS, KATHLEEN BRONNER (LCSW)
Entity type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:BRONNER
Last Name:FIKS
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 1:83 GLENWOOD RD
Mailing Address - Street 2:
Mailing Address - City:TENAFLY
Mailing Address - State:NJ
Mailing Address - Zip Code:07670-1135
Mailing Address - Country:US
Mailing Address - Phone:201-569-1819
Mailing Address - Fax:201-568-4494
Practice Address - Street 1:10848 70TH RD
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-3961
Practice Address - Country:US
Practice Address - Phone:718-261-3696
Practice Address - Fax:201-568-4494
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0060781041C0700X
NJ44SC000903001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
053065OtherMHS VALUE OPTIONS
P582628OtherOXFORD
7485794VOtherVALUE BEHAVIRAL
0082408OtherGHI
NY04101Medicare ID - Type Unspecified
053065OtherMHS VALUE OPTIONS