Provider Demographics
NPI:1588148621
Name:MUNGER, KATIE BETH (LPC)
Entity type:Individual
Prefix:MRS
First Name:KATIE
Middle Name:BETH
Last Name:MUNGER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:432 PAXSON AVE
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08690-1915
Mailing Address - Country:US
Mailing Address - Phone:609-577-6646
Mailing Address - Fax:
Practice Address - Street 1:70 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CRANBURY
Practice Address - State:NJ
Practice Address - Zip Code:08512-3140
Practice Address - Country:US
Practice Address - Phone:609-577-6646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-24
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00499700101YM0800X
NJ3TPC00499700101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health