Provider Demographics
NPI:1871768374
Name:HANES, KATHLEEN M (LPC DEGREES ARE MCAT)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:M
Last Name:HANES
Suffix:
Gender:F
Credentials:LPC DEGREES ARE MCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 ROBERTS DR
Mailing Address - Street 2:
Mailing Address - City:WESTAMPTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08060
Mailing Address - Country:US
Mailing Address - Phone:609-923-0597
Mailing Address - Fax:
Practice Address - Street 1:256 BANN DR
Practice Address - Street 2:#6
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540
Practice Address - Country:US
Practice Address - Phone:609-452-1110
Practice Address - Fax:609-921-3620
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-25
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNJ000884101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional