Healthcare Provider Details

I. General information

NPI: 1619199825
Provider Name (Legal Business Name): CATHERINE A ENSANA M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 SAINT DAVIDS PL
SOUTHAMPTON NJ
08088-1126
US

IV. Provider business mailing address

34 SAINT DAVIDS PL
SOUTHAMPTON NJ
08088-1126
US

V. Phone/Fax

Practice location:
  • Phone: 609-234-7964
  • Fax: 609-859-3855
Mailing address:
  • Phone: 609-234-7964
  • Fax: 609-859-3855

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number37PC00064000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: