Healthcare Provider Details

I. General information

NPI: 1467535922
Provider Name (Legal Business Name): MARY ANN KEZMARSKY PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 SHERIDAN AVENUE SUITE 1
HO-HO-KUS NJ
07423
US

IV. Provider business mailing address

PO BOX 325
HO-HO-KUS NJ
07423-0325
US

V. Phone/Fax

Practice location:
  • Phone: 201-251-8555
  • Fax: 201-251-9595
Mailing address:
  • Phone: 201-251-8555
  • Fax: 201-251-9595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number02822
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number02822
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: