Healthcare Provider Details

I. General information

NPI: 1639225881
Provider Name (Legal Business Name): KATHRYN CAPAWANA LCSW, LCADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2007
Last Update Date: 04/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

645 WESTWOOD AVENUE SUITE 204
RIVERVALE NJ
07675-6295
US

IV. Provider business mailing address

645 WESTWOOD AVE STE 204
RIVER VALE NJ
07675-5300
US

V. Phone/Fax

Practice location:
  • Phone: 201-895-6402
  • Fax:
Mailing address:
  • Phone: 201-895-6402
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberNJLCADC37LC00126400
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberNJLCSW44SC0518800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: