Provider Demographics
NPI:1336974237
Name:KANE, PAMELA (LSW)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:KANE
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 WARDELL CIR
Mailing Address - Street 2:
Mailing Address - City:OCEANPORT
Mailing Address - State:NJ
Mailing Address - Zip Code:07757-1610
Mailing Address - Country:US
Mailing Address - Phone:732-513-7580
Mailing Address - Fax:
Practice Address - Street 1:62 WARDELL CIR
Practice Address - Street 2:
Practice Address - City:OCEANPORT
Practice Address - State:NJ
Practice Address - Zip Code:07757-1610
Practice Address - Country:US
Practice Address - Phone:732-513-7580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-03
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL056052001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical