MEDICARE: MRS. TANJA KATICA FRADE MSW, LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	44SC05506400	NJ

General Provider Information

NPI Number	:	1265776819
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TANJA KATICA FRADE MSW, LCSW

Provider Business Mailing Address
First Line	:	124 CHESTNUT TER
Second Line	:
City	:	ROCKAWAY
State	:	NJ
Zip	:	07866-2429
Country	:	US
Telephone Number	:	908-229-3138
Fax Number	:

Provider Business Practice Location Address
First Line	:	5 REGENT ST BLDG 5S
Second Line	:	SUITE 518
City	:	LIVINGSTON
State	:	NJ
Zip	:	07039-1675
Country	:	US
Telephone Number	:	908-229-3138
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/20/2012
Last Update Date	:	11/20/2013

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