Provider Demographics
NPI:1588796387
Name:KLOSEK, RICHARD JOSEPH (MSW)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:JOSEPH
Last Name:KLOSEK
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1230 MAMARONECK AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10605-5229
Mailing Address - Country:US
Mailing Address - Phone:914-637-9691
Mailing Address - Fax:914-637-9684
Practice Address - Street 1:1230 MAMARONECK AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10605-5229
Practice Address - Country:US
Practice Address - Phone:914-637-9691
Practice Address - Fax:914-637-9684
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2011-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR052316-21041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical