Provider Demographics
NPI:1609232537
Name:BACSIK, KERRY ANNE
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:ANNE
Last Name:BACSIK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 JONES MILL RD
Mailing Address - Street 2:
Mailing Address - City:WRIGHTSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08562-1808
Mailing Address - Country:US
Mailing Address - Phone:800-424-9610
Mailing Address - Fax:609-770-4443
Practice Address - Street 1:30 JONES MILL RD
Practice Address - Street 2:
Practice Address - City:WRIGHTSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08562-1808
Practice Address - Country:US
Practice Address - Phone:800-424-9610
Practice Address - Fax:609-770-4443
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-07
Last Update Date:2016-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator