Healthcare Provider Details

I. General information

NPI: 1124731435
Provider Name (Legal Business Name): KARINA PESAH LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2023
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 MAIN AVE
PASSAIC NJ
07055-4427
US

IV. Provider business mailing address

133 AMSTERDAM AVE
PASSAIC NJ
07055-2443
US

V. Phone/Fax

Practice location:
  • Phone: 973-777-7638
  • Fax:
Mailing address:
  • Phone: 201-255-7975
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC06680900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: