=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215117148
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHERYL KRAMER LCSW, DSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/08/2007
-----------------------------------------------------
Last Update Date | 11/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10 W IVY LN SUITE #5
-----------------------------------------------------
City | ENGLEWOOD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07631-6705
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-541-1555
-----------------------------------------------------
Fax | 201-871-7346
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10 IVY LANE SUITE #5
-----------------------------------------------------
City | ENGLEWOOD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07631
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-541-1555
-----------------------------------------------------
Fax | 201-871-7346
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 44SC00447900
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------