Provider Demographics
NPI:1902023393
Name:PIERSANTI, ROBERT J (LCSW)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:J
Last Name:PIERSANTI
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 1:39 WILRUE PKWY
Mailing Address - Street 2:
Mailing Address - City:POMPTON PLAINS
Mailing Address - State:NJ
Mailing Address - Zip Code:07444-1717
Mailing Address - Country:US
Mailing Address - Phone:201-618-3616
Mailing Address - Fax:
Practice Address - Street 1:39 WILRUE PKWY
Practice Address - Street 2:
Practice Address - City:POMPTON PLAINS
Practice Address - State:NJ
Practice Address - Zip Code:07444-1717
Practice Address - Country:US
Practice Address - Phone:201-618-3616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2022-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC051935001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
067772Medicare UPIN
067772Medicare Oscar/Certification
067772Medicare PIN