Provider Demographics
NPI:1609092931
Name:DROBNICK, RICHARD S (LCSW)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:S
Last Name:DROBNICK
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:691 CEDAR LANE
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-1702
Mailing Address - Country:US
Mailing Address - Phone:201-692-0508
Mailing Address - Fax:201-692-1691
Practice Address - Street 1:691 CEDAR LANE
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666
Practice Address - Country:US
Practice Address - Phone:201-692-0508
Practice Address - Fax:201-692-1691
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC000406001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ641821Medicare ID - Type Unspecified