Provider Demographics
NPI:1831783588
Name:LITWAK, KENNETH MARTIN II (CADC)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:MARTIN
Last Name:LITWAK
Suffix:II
Gender:M
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 E LINDLEY AVE
Mailing Address - Street 2:
Mailing Address - City:PLEASANTVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08232-1122
Mailing Address - Country:US
Mailing Address - Phone:609-328-0890
Mailing Address - Fax:
Practice Address - Street 1:46 E LINDLEY AVE
Practice Address - Street 2:
Practice Address - City:PLEASANTVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08232-1122
Practice Address - Country:US
Practice Address - Phone:609-328-0890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-23
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37CA00155100101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NONEOtherNONE