Provider Demographics
NPI:1508448796
Name:CECHULSKI, KRYSTYNA (LCSW)
Entity Type:Individual
Prefix:
First Name:KRYSTYNA
Middle Name:
Last Name:CECHULSKI
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:PO BOX 1037
Mailing Address - Street 2:
Mailing Address - City:OCEAN GATE
Mailing Address - State:NJ
Mailing Address - Zip Code:08740-1037
Mailing Address - Country:US
Mailing Address - Phone:848-373-6500
Mailing Address - Fax:
Practice Address - Street 1:814 NAVESINK AVE
Practice Address - Street 2:
Practice Address - City:OCEAN GATE
Practice Address - State:NJ
Practice Address - Zip Code:08740-1377
Practice Address - Country:US
Practice Address - Phone:848-373-6500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-27
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC05993500104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker