Provider Demographics
NPI:1902519580
Name:PHAGOO, KAMALWATTIE
Entity Type:Individual
Prefix:
First Name:KAMALWATTIE
Middle Name:
Last Name:PHAGOO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1612 FORD AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07080-1532
Mailing Address - Country:US
Mailing Address - Phone:908-421-0520
Mailing Address - Fax:
Practice Address - Street 1:6 AUER CT STE D
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-5828
Practice Address - Country:US
Practice Address - Phone:732-390-0007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-28
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC061282001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical