Basic Information
| Provider Information | |||||||||
| NPI: | 1679963979 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CZESAK | ||||||||
| FirstName: | ASHLEY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 483 QUINCE CT | ||||||||
| Address2: | |||||||||
| City: | MAHWAH | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 074302090 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2017257852 | ||||||||
| FaxNumber: | 2017975025 | ||||||||
| Practice Location | |||||||||
| Address1: | 17-07 ROMAINE ST | ||||||||
| Address2: | |||||||||
| City: | FAIR LAWN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 074102150 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2017972660 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/26/2015 | ||||||||
| LastUpdateDate: | 01/26/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 44SL06000200 | NJ | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.