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General NPI Number Information
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NPI Number | 1730738907
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Entity Type | Individual
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Provider Name | KATHRYN JO GORGA LAC, ATR-P
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Gender | Female
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Dates
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Enumeration Date | 09/10/2019
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Last Update Date | 09/15/2019
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Provider Practice Location Address
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Address Line | 166 MAIN ST
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City | MATAWAN
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State | NJ
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Zip | 07747-3104
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Country | US
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Telephone | 732-290-9040
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Fax |
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Provider Business Mailing Address
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Address Line | 1007 MAIN ST APT 2
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City | BELMAR
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State | NJ
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Zip | 07719-2786
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Country | US
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Telephone | 908-461-2437
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State | NJ
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