Healthcare Provider Details

I. General information

NPI: 1205730744
Provider Name (Legal Business Name): KATIE J SQUINDO LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

76 W JIMMIE LEEDS RD STE 305
GALLOWAY NJ
08205-9418
US

IV. Provider business mailing address

120 MASON AVE
HAMILTON NJ
08610-4813
US

V. Phone/Fax

Practice location:
  • Phone: 609-916-6500
  • Fax:
Mailing address:
  • Phone: 732-839-5099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number37AC00880200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: