Healthcare Provider Details

I. General information

NPI: 1396607743
Provider Name (Legal Business Name): OLIVIA ANNE KOLOSZUK LCSW; LCADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/24/2025
Last Update Date: 11/24/2025
Certification Date: 11/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

837 RIDGE RD
KEYPORT NJ
07735-5214
US

IV. Provider business mailing address

837 RIDGE RD
KEYPORT NJ
07735-5214
US

V. Phone/Fax

Practice location:
  • Phone: 201-638-3947
  • Fax:
Mailing address:
  • Phone: 201-638-3947
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC06559600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: