Healthcare Provider Details

I. General information

NPI: 1811941990
Provider Name (Legal Business Name): KATHERINE LOUISE CARUGNO MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: MISS KATHERINE LOUISE BOYLES

II. Dates (important events)

Enumeration Date: 05/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

347 N MAIN ST
MANAHAWKIN NJ
08050-3015
US

IV. Provider business mailing address

PO BOX 529
LITTLE EGG HARBOR TWP NJ
08087-0529
US

V. Phone/Fax

Practice location:
  • Phone: 609-978-6083
  • Fax:
Mailing address:
  • Phone: 609-978-6083
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC04576700
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier2244568000
Identifier TypeOTHER
Identifier State
Identifier IssuerAMERIHEALTH
# 2
Identifier7908290
Identifier TypeOTHER
Identifier State
Identifier IssuerAETNA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: