Healthcare Provider Details

I. General information

NPI: 1871129452
Provider Name (Legal Business Name): CATHERINE OTTAVIANO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2020
Last Update Date: 03/16/2020
Certification Date: 03/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 NEW RD FL 2
LINWOOD NJ
08221-1121
US

IV. Provider business mailing address

1212 TODD CT
LAKEWOOD NJ
08701-2256
US

V. Phone/Fax

Practice location:
  • Phone: 609-225-9355
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC05919300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: