Provider Demographics
NPI:1619307063
Name:ZACHARCZYK, DANA (LSW, ACM, C-ASWCM)
Entity Type:Individual
Prefix:MRS
First Name:DANA
Middle Name:
Last Name:ZACHARCZYK
Suffix:
Gender:F
Credentials:LSW, ACM, C-ASWCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1945 HIGHWAY 33
Mailing Address - Street 2:JSUMC
Mailing Address - City:NEPTUNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07753
Mailing Address - Country:US
Mailing Address - Phone:732-775-5500
Mailing Address - Fax:732-776-4690
Practice Address - Street 1:1945 HIGHWAY 33
Practice Address - Street 2:JSUMC
Practice Address - City:NEPTUNE
Practice Address - State:NJ
Practice Address - Zip Code:07753-4859
Practice Address - Country:US
Practice Address - Phone:732-775-5500
Practice Address - Fax:732-776-4690
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-21
Last Update Date:2013-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL05226700104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker