Healthcare Provider Details

I. General information

NPI: 1932062452
Provider Name (Legal Business Name): JUSTIN DANIEL CHERNICK MSW, LSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2025
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

852 KINDERKAMACK RD
RIVER EDGE NJ
07661-2324
US

IV. Provider business mailing address

904 ALAN PL
RIDGEFIELD NJ
07657-1708
US

V. Phone/Fax

Practice location:
  • Phone: 201-228-3671
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number44SL07396200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: