Provider Demographics
NPI:1851526156
Name:KLACHKIN, RITA HOFFMAN (LAC, LCAT)
Entity Type:Individual
Prefix:MS
First Name:RITA
Middle Name:HOFFMAN
Last Name:KLACHKIN
Suffix:
Gender:F
Credentials:LAC, LCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:184 S LIVINGSTON AVE
Mailing Address - Street 2:#9181
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-3014
Mailing Address - Country:US
Mailing Address - Phone:973-454-6087
Mailing Address - Fax:317-947-2728
Practice Address - Street 1:184 S LIVINGSTON AVE
Practice Address - Street 2:#9181
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-3014
Practice Address - Country:US
Practice Address - Phone:973-454-6087
Practice Address - Fax:317-947-2728
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-16
Last Update Date:2009-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00025600101Y00000X
NY001104101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor