Healthcare Provider Details

I. General information

NPI: 1558060012
Provider Name (Legal Business Name): COLLEEN FERENCHAK LCSW, LCADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2023
Last Update Date: 07/12/2026
Certification Date: 07/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 S HOLMDEL RD
HOLMDEL NJ
07733-2130
US

IV. Provider business mailing address

4 S HOLMDEL RD
HOLMDEL NJ
07733-2130
US

V. Phone/Fax

Practice location:
  • Phone: 732-788-6232
  • Fax:
Mailing address:
  • Phone: 732-788-6232
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number37LC00395400
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC06277800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: