Provider Demographics
NPI:1134154503
Name:KIRCHNER GLANZ, STACEY MARIE (MSW LCSW)
Entity type:Individual
Prefix:MS
First Name:STACEY
Middle Name:MARIE
Last Name:KIRCHNER GLANZ
Suffix:
Gender:F
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 1:218 ROUTE 17 NORTH
Mailing Address - Street 2:SUITE 303
Mailing Address - City:ROCHELLE PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07662-3399
Mailing Address - Country:US
Mailing Address - Phone:201-488-6543
Mailing Address - Fax:
Practice Address - Street 1:218 ROUTE 17 NORTH
Practice Address - Street 2:SUITE 303
Practice Address - City:ROCHELLE PARK
Practice Address - State:NJ
Practice Address - Zip Code:07662-3399
Practice Address - Country:US
Practice Address - Phone:201-488-6543
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2013-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC04648G001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ005141Medicare PIN