Provider Demographics
NPI:1619385176
Name:CRYSTAL ZELMAN LLC
Entity Type:Organization
Organization Name:CRYSTAL ZELMAN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:L
Authorized Official - Last Name:ZELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, CCLS, RPT
Authorized Official - Phone:862-242-0559
Mailing Address - Street 1:76 BROADWAY
Mailing Address - Street 2:SUITE 200H
Mailing Address - City:DENVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07834-2764
Mailing Address - Country:US
Mailing Address - Phone:862-242-0559
Mailing Address - Fax:
Practice Address - Street 1:76 BROADWAY
Practice Address - Street 2:SUITE 200H
Practice Address - City:DENVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07834-2764
Practice Address - Country:US
Practice Address - Phone:862-242-0559
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-29
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC054626001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty