Healthcare Provider Details

I. General information

NPI: 1437855459
Provider Name (Legal Business Name): ASHLEY CZESAK PSYCHOTHERAPY & WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2023
Last Update Date: 07/06/2023
Certification Date: 07/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11-13 SUNFLOWER AVE STE 1040
PARAMUS NJ
07652-3754
US

IV. Provider business mailing address

2 KELLER CT
PARK RIDGE NJ
07656-1669
US

V. Phone/Fax

Practice location:
  • Phone: 201-725-7852
  • Fax:
Mailing address:
  • Phone: 201-725-7852
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1679963979
Identifier TypeOTHER
Identifier StateNJ
Identifier IssuerBCBS
# 2
Identifier22099
Identifier TypeOTHER
Identifier State
Identifier IssuerHORIZON BLUE CROSS BLUE SHIELD

VIII. Authorized Official

Name: ASHLEY CZESAK
Title or Position: OWNER
Credential: LCSW
Phone: 201-725-7852