=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417374232
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JUDITH R KUSKIN, MSW, LCSW
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/19/2014
-----------------------------------------------------
Last Update Date | 03/19/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 25 FRANKLIN PL
-----------------------------------------------------
City | SUMMIT
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07901-3616
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-410-6967
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 23 DRUM HILL DR
-----------------------------------------------------
City | SUMMIT
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07901-3106
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-277-6183
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LICENSED CLINICAL SOCIAL WORKER
-----------------------------------------------------
Name | MS. JUDITH R KUSKIN
-----------------------------------------------------
Credential | MSW, LCSW
-----------------------------------------------------
Telephone | 908-277-6183
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 44SC05495100
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------