Healthcare Provider Details

I. General information

NPI: 1326928771
Provider Name (Legal Business Name): DONNA GERGASKO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2025
Last Update Date: 09/05/2025
Certification Date: 09/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 SCOTCH RD FL 2
EWING NJ
08628-2529
US

IV. Provider business mailing address

27 KENWOOD TER
HAMILTON NJ
08610-2504
US

V. Phone/Fax

Practice location:
  • Phone: 609-699-0498
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number37CA00153400
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number44SL07169400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: