Provider Demographics
NPI:1437855459
Name:ASHLEY CZESAK PSYCHOTHERAPY & WELLNESS LLC
Entity Type:Organization
Organization Name:ASHLEY CZESAK PSYCHOTHERAPY & WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:CZESAK
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:201-725-7852
Mailing Address - Street 1:2 KELLER CT
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07656-1669
Mailing Address - Country:US
Mailing Address - Phone:201-725-7852
Mailing Address - Fax:
Practice Address - Street 1:11-13 SUNFLOWER AVE STE 1040
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-3754
Practice Address - Country:US
Practice Address - Phone:201-725-7852
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-01
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1679963979OtherBCBS
22099OtherHORIZON BLUE CROSS BLUE SHIELD