Provider Demographics
NPI:1851722953
Name:PACKARD, RONALD B (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:B
Last Name:PACKARD
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 ROCKLAND AVE UNIT 5
Mailing Address - Street 2:
Mailing Address - City:HILLBURN
Mailing Address - State:NY
Mailing Address - Zip Code:10931-1170
Mailing Address - Country:US
Mailing Address - Phone:609-306-1160
Mailing Address - Fax:
Practice Address - Street 1:595 CHESTNUT ROAD SUITE 4
Practice Address - Street 2:
Practice Address - City:WOODCLIFF LAKE
Practice Address - State:NJ
Practice Address - Zip Code:07667-7663
Practice Address - Country:US
Practice Address - Phone:732-982-2888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-29
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC057077001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical