Provider Demographics
NPI:1457401325
Name:ZIETCHICK, DANIEL E (LCSW)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:E
Last Name:ZIETCHICK
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 1:2240 CHURCH ROAD
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-8152
Mailing Address - Country:US
Mailing Address - Phone:732-255-1220
Mailing Address - Fax:732-255-1220
Practice Address - Street 1:2240 CHURCH ROAD
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-8152
Practice Address - Country:US
Practice Address - Phone:732-255-1220
Practice Address - Fax:732-255-1220
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2010-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC003529001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ053396000OtherMAGELLAN
NJ11235214OtherCAQH
NJ053396000OtherMAGELLAN