Provider Demographics
NPI:1427342955
Name:BISHOP, KATHLEEN GAYLE (MDIV, PHD)
Entity type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:GAYLE
Last Name:BISHOP
Suffix:
Gender:F
Credentials:MDIV, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 OCEAN AVE
Mailing Address - Street 2:#30
Mailing Address - City:LONG BRANCH
Mailing Address - State:NJ
Mailing Address - Zip Code:07740-5368
Mailing Address - Country:US
Mailing Address - Phone:201-602-4803
Mailing Address - Fax:
Practice Address - Street 1:9 TULIP ST
Practice Address - Street 2:
Practice Address - City:SUMMIT
Practice Address - State:NJ
Practice Address - Zip Code:07901-2404
Practice Address - Country:US
Practice Address - Phone:908-277-7676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-01
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ3TP10-017106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist