Healthcare Provider Details

I. General information

NPI: 1003349374
Provider Name (Legal Business Name): KATHERINE A PASEKA M.ED.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2017
Last Update Date: 04/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 OVERLOOK RD MAC II - SUITE 200
SUMMIT NJ
07901-3577
US

IV. Provider business mailing address

99 BEAUVOIR AVE MAC II - SUITE 200
SUMMIT NJ
07901-3533
US

V. Phone/Fax

Practice location:
  • Phone: 908-522-3849
  • Fax: 908-522-5779
Mailing address:
  • Phone: 908-522-3849
  • Fax: 908-522-5779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37PC00585600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: