Provider Demographics
NPI:1912098708
Name:CAEZZA, KATHLEEN JULIE (LCSW-R)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:JULIE
Last Name:CAEZZA
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 113
Mailing Address - Street 2:
Mailing Address - City:ONEIDA
Mailing Address - State:NY
Mailing Address - Zip Code:13421-0113
Mailing Address - Country:US
Mailing Address - Phone:315-361-4159
Mailing Address - Fax:
Practice Address - Street 1:112 FARRIER AVE STE 304
Practice Address - Street 2:
Practice Address - City:ONEIDA
Practice Address - State:NY
Practice Address - Zip Code:13421-1637
Practice Address - Country:US
Practice Address - Phone:315-361-4159
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0377361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP20068Medicare UPIN
NYCC3601Medicare ID - Type Unspecified