Provider Demographics
NPI:1811584931
Name:CZERMAK, PHILLIP Z (LCSW)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:Z
Last Name:CZERMAK
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 1:29 COLES WAY
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-4876
Mailing Address - Country:US
Mailing Address - Phone:908-910-4740
Mailing Address - Fax:
Practice Address - Street 1:254 BRICK BLVD UNIT 3C
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08723-7170
Practice Address - Country:US
Practice Address - Phone:908-910-4740
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-22
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC059407001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical