Provider Demographics
NPI:1285170126
Name:NAZARIO, KAITLIN (LPC, ACS)
Entity type:Individual
Prefix:
First Name:KAITLIN
Middle Name:
Last Name:NAZARIO
Suffix:
Gender:F
Credentials:LPC, ACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:179 RTE 46 STE 15
Mailing Address - Street 2:
Mailing Address - City:ROCKAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:07866-4046
Mailing Address - Country:US
Mailing Address - Phone:973-400-9217
Mailing Address - Fax:
Practice Address - Street 1:179 RTE 46 STE 15
Practice Address - Street 2:
Practice Address - City:ROCKAWAY
Practice Address - State:NJ
Practice Address - Zip Code:07866-4046
Practice Address - Country:US
Practice Address - Phone:973-400-9217
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-17
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00612400101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional