Provider Demographics
NPI:1417036724
Name:PORESKY, RICHARD J (LCSW MSW MPH DHA MA)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:J
Last Name:PORESKY
Suffix:
Gender:M
Credentials:LCSW MSW MPH DHA MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 WASHINGTON ST
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08721
Mailing Address - Country:US
Mailing Address - Phone:732-240-1382
Mailing Address - Fax:732-240-9268
Practice Address - Street 1:1541 RTE 37 E
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-5717
Practice Address - Country:US
Practice Address - Phone:732-270-2924
Practice Address - Fax:732-240-9268
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC05227000104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ084079Medicare ID - Type Unspecified