Provider Demographics
NPI:1386167633
Name:GANGE, KATHARINE LUISE (MSW)
Entity type:Individual
Prefix:
First Name:KATHARINE
Middle Name:LUISE
Last Name:GANGE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:KATHARINE
Other - Middle Name:LUISE
Other - Last Name:GANGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1225 MORRIS PARK AVENUE
Mailing Address - Street 2:PEDS-CERC
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461
Mailing Address - Country:US
Mailing Address - Phone:718-839-7159
Mailing Address - Fax:
Practice Address - Street 1:1225 MORRIS PARK AVENUE
Practice Address - Street 2:PEDS-CERC
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461
Practice Address - Country:US
Practice Address - Phone:718-839-7159
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP06890104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker