Provider Demographics
NPI:1811321813
Name:PANSKY, ANDREW SAMUEL (LCSW, LCADC)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:SAMUEL
Last Name:PANSKY
Suffix:
Gender:M
Credentials:LCSW, LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 N FRANKLIN TPKE STE 110
Mailing Address - Street 2:
Mailing Address - City:RAMSEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07446-1634
Mailing Address - Country:US
Mailing Address - Phone:201-574-7065
Mailing Address - Fax:
Practice Address - Street 1:145 N FRANKLIN TPKE STE 110
Practice Address - Street 2:
Practice Address - City:RAMSEY
Practice Address - State:NJ
Practice Address - Zip Code:07446-1634
Practice Address - Country:US
Practice Address - Phone:201-574-7065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-26
Last Update Date:2019-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00270700101YA0400X
NJ44SC056877001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)