Healthcare Provider Details

I. General information

NPI: 1811822786
Provider Name (Legal Business Name): IAN ALCAZAR LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

349 MAOLIS AVE
GLEN RIDGE NJ
07028-2110
US

IV. Provider business mailing address

349 MAOLIS AVE
GLEN RIDGE NJ
07028-2110
US

V. Phone/Fax

Practice location:
  • Phone: 917-757-9081
  • Fax:
Mailing address:
  • Phone: 917-757-9081
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number069494-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: