Provider Demographics
NPI:1457683708
Name:LITWAK, MARIADONNA M (LCSW)
Entity Type:Individual
Prefix:
First Name:MARIADONNA
Middle Name:M
Last Name:LITWAK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:498 LONG AVE
Mailing Address - Street 2:
Mailing Address - City:MANASQUAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08736-3302
Mailing Address - Country:US
Mailing Address - Phone:732-223-1649
Mailing Address - Fax:
Practice Address - Street 1:498 LONG AVE
Practice Address - Street 2:
Practice Address - City:MANASQUAN
Practice Address - State:NJ
Practice Address - Zip Code:08736-3302
Practice Address - Country:US
Practice Address - Phone:732-223-1649
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-10
Last Update Date:2010-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC052695001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical