Healthcare Provider Details

I. General information

NPI: 1699210559
Provider Name (Legal Business Name): KATHLEEN P BUZZONE-BROOKS MSW, LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2017
Last Update Date: 01/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

522 BRICK BLVD
BRICK NJ
08723-6089
US

IV. Provider business mailing address

2 VICTORIAN WOODS DR
ATLANTIC HIGHLANDS NJ
07716-1500
US

V. Phone/Fax

Practice location:
  • Phone: 732-240-2545
  • Fax: 732-475-6265
Mailing address:
  • Phone: 732-240-2545
  • Fax: 732-475-6265

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number44SL06237500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: