=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821160789
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CYNTHIA V KATES MSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/15/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 52 E MAIN ST
-----------------------------------------------------
City | FLEMINGTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08822-1224
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-466-4468
-----------------------------------------------------
Fax | 609-466-4468
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 24 BURD LN
-----------------------------------------------------
City | HOPEWELL
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08525-2612
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-466-4468
-----------------------------------------------------
Fax | 609-466-4468
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | SC05224100
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | CW013807
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------