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General NPI Number Information
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NPI Number | 1336455385
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Entity Type | Individual
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Provider Name | KERRY PLOKHOY LCSW
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Gender | Female
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Dates
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Enumeration Date | 08/27/2010
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Last Update Date | 08/15/2011
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Provider Practice Location Address
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Address Line | 120 CHESTNUT ST
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City | RIDGEWOOD
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State | NJ
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Zip | 07450-2504
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Country | US
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Telephone | 201-934-1160
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Fax |
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Provider Business Mailing Address
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Address Line | 21 PINE LN
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City | WEST MILFORD
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State | NJ
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Zip | 07480-2354
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Country | US
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Telephone | 201-841-2780
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 44SC05468900
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License Number State | NJ
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