Healthcare Provider Details

I. General information

NPI: 1962574798
Provider Name (Legal Business Name): KATHRYN LOGOYDA MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 08/17/2021
Certification Date: 08/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 MAIN ST STE 206
METUCHEN NJ
08840-1844
US

IV. Provider business mailing address

402 MAIN ST STE 206
METUCHEN NJ
08840-1844
US

V. Phone/Fax

Practice location:
  • Phone: 732-494-5525
  • Fax: 732-494-5525
Mailing address:
  • Phone: 732-494-5525
  • Fax: 732-494-5525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC04514100
License Number StateNJ

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: