Healthcare Provider Details

I. General information

NPI: 1336455385
Provider Name (Legal Business Name): KERRY PLOKHOY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2010
Last Update Date: 08/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 CHESTNUT ST
RIDGEWOOD NJ
07450-2504
US

IV. Provider business mailing address

21 PINE LN
WEST MILFORD NJ
07480-2354
US

V. Phone/Fax

Practice location:
  • Phone: 201-934-1160
  • Fax:
Mailing address:
  • Phone: 201-841-2780
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number44SC05468900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: