Healthcare Provider Details

I. General information

NPI: 1902188915
Provider Name (Legal Business Name): KATHRYN CAPAWANA, LCSW, LCADC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2011
Last Update Date: 09/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

645 WESTWOOD AVE SUITE 204
RIVERVALE NJ
07675-6295
US

IV. Provider business mailing address

645 WESTWOOD AVE SUITE 204
RIVERVALE NJ
07675-6295
US

V. Phone/Fax

Practice location:
  • Phone: 201-895-6402
  • Fax: 201-358-1386
Mailing address:
  • Phone: 201-895-6402
  • Fax: 201-358-1386

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC05158800
License Number StateNJ

VIII. Authorized Official

Name: KATHRYN CAPAWANA
Title or Position: OWNER
Credential: LCSW, LCADC
Phone: 201-895-6402