Provider Demographics
NPI:1366658866
Name:KAKOLEWSKI, JOHN A (MS,EDS)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:A
Last Name:KAKOLEWSKI
Suffix:
Gender:M
Credentials:MS,EDS
Other - Prefix:MR
Other - First Name:JOHN
Other - Middle Name:A
Other - Last Name:KAKOLEWSKI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS,EDS
Mailing Address - Street 1:456 BEVERLY RD
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-3308
Mailing Address - Country:US
Mailing Address - Phone:201-445-6670
Mailing Address - Fax:201-652-5543
Practice Address - Street 1:88 W RIDGEWOOD AVE
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-3199
Practice Address - Country:US
Practice Address - Phone:201-445-6670
Practice Address - Fax:201-652-5543
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ982106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist