MEDICARE: KITCHEN TABLE THERAPY, LLC

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	104100000X	Social Worker	44SC00586800	NJ

General Provider Information

NPI Number	:	1275840332
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KITCHEN TABLE THERAPY, LLC

Provider Business Mailing Address
First Line	:	31 NEWFIELD STREET
Second Line	:
City	:	EAST ORANGE
State	:	NJ
Zip	:	07017-5410
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	31 NEWFIELD STREET
Second Line	:
City	:	EAST ORANGE
State	:	NJ
Zip	:	07017-5410
Country	:	US
Telephone Number	:	201-725-1807
Fax Number	:

Authorized Official
Title or Position	:	HEALTHCARE PROVIDER
Name	:	CHARLENE W MASON-REESE
Credential	:
Telephone Number	:	201-725-1807

Provider Enumeration Date	:	09/09/2010
Last Update Date	:	09/09/2010

Similar Medicare Providers

1174798433 — ORANGE COUNTY NEWBORN MEDICARE CARE PC
Practice Location Address:

3 SAINT STEPHENS PL , SUITE 2
WARWICK, NY
10990-3208

Practice Phone: 845-987-9700
Practice Fax:

1144371899 — MS. CHARLENE W. MASON-REESE LCSW
Practice Location Address:

31 NEWFIELD ST , #2
EAST ORANGE, NJ
07017-5410

Practice Phone: 201-725-1807
Practice Fax: 908-820-4290

1982023834 — MARISSA CHUNN BCBA
Practice Location Address:

2015 DOCTORS LAKE DR
ORANGE PARK, FL
32073-5410

Practice Phone: 904-644-8632
Practice Fax: 904-644-8753

1881400844 — DR. JONATHAN REYES CARTAGENA
Practice Location Address:

5410 S WILLIAMSON BLVD APT 6-104
PORT ORANGE, FL
32128-7368

Practice Phone: 787-362-8584
Practice Fax:

1447294061 — MRS. SHANNON ALISON HARTMAN-WILSON MA, LMFT,
Practice Location Address:

5410 EAST 30A , SUITE 212
SANTA ROSA BEACH, FL
32459

Practice Phone: 850-607-9108
Practice Fax:

1437370772 — PARKSIDE, INC.
Practice Location Address:

1619 EAST 13TH STREET
TULSA, OK
74120-5410

Practice Phone: 918-582-2131
Practice Fax:

Directions to “KITCHEN TABLE THERAPY, LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.