Healthcare Provider Details

I. General information

NPI: 1922588979
Provider Name (Legal Business Name): KRISTI ZYBULEWSKI MSW, LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2018
Last Update Date: 08/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94 VALLEY RD STE 302
MONTCLAIR NJ
07042-2211
US

IV. Provider business mailing address

40 BROADVIEW AVE
MAPLEWOOD NJ
07040-3622
US

V. Phone/Fax

Practice location:
  • Phone: 973-637-0664
  • Fax:
Mailing address:
  • Phone: 973-762-7937
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number44SL06364000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: