Healthcare Provider Details

I. General information

NPI: 1801119896
Provider Name (Legal Business Name): PERSONAL SOLUTIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2010
Last Update Date: 03/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

297 KINDERKAMACK ROAD SUITE 212
ORADELL NJ
07649
US

IV. Provider business mailing address

297 KINDERKAMACK ROAD SUITE 212
ORADELL NJ
07649
US

V. Phone/Fax

Practice location:
  • Phone: 201-690-6760
  • Fax: 201-967-1346
Mailing address:
  • Phone: 201-690-6760
  • Fax: 201-967-1346

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC0430110
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number37LC00056100
License Number StateNJ

VIII. Authorized Official

Name: STACEY GLICK-NOVACK
Title or Position: CLINICIAN/COUNSELOR
Credential: LCSW, LCADC
Phone: 201-690-6760