Provider Demographics
NPI:1396806766
Name:RHOADES, KATHERINE A (MD)
Entity type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:A
Last Name:RHOADES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:KATHERINE
Other - Middle Name:A
Other - Last Name:RHOADES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:B1 CORNWALL DR
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-3361
Mailing Address - Country:US
Mailing Address - Phone:732-257-0755
Mailing Address - Fax:732-257-6177
Practice Address - Street 1:B1 CORNWALL DR
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-3361
Practice Address - Country:US
Practice Address - Phone:732-257-0755
Practice Address - Fax:732-257-6177
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJSI03644103TF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily