Provider Demographics
NPI:1780700054
Name:VARTOUKIAN, QUEENIE (LCSW)
Entity type:Individual
Prefix:MS
First Name:QUEENIE
Middle Name:
Last Name:VARTOUKIAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 CARMITA AVE
Mailing Address - Street 2:
Mailing Address - City:RUTHERFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07070-1124
Mailing Address - Country:US
Mailing Address - Phone:201-896-0215
Mailing Address - Fax:
Practice Address - Street 1:118 UNION AVE
Practice Address - Street 2:
Practice Address - City:RUTHERFORD
Practice Address - State:NJ
Practice Address - Zip Code:07070-1124
Practice Address - Country:US
Practice Address - Phone:201-896-0210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC000074001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1129362OtherHORIZON BC BSHIELD OF NJ
NJ1129362OtherHORIZON BC BSHIELD OF NJ