MEDICARE: MS. KATHLEEN A PASTIRIK MSW LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	44SC04608000	NJ

General Provider Information

NPI Number	:	1790968840
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KATHLEEN A PASTIRIK MSW LCSW

Provider Business Mailing Address
First Line	:	35 WASHINGTON COURT
Second Line	:
City	:	TOWACO
State	:	NJ
Zip	:	07082-1271
Country	:	US
Telephone Number	:	973-335-8260
Fax Number	:

Provider Business Practice Location Address
First Line	:	65 NORTH MAPLE AVE
Second Line	:
City	:	RIDGEWOOD
State	:	NJ
Zip	:	07450-3233
Country	:	US
Telephone Number	:	201-230-0782
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/12/2007
Last Update Date	:	12/12/2007

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