Provider Demographics
NPI:1902431612
Name:KAZANSKY, HARRIET PHYLLIS (LCSW)
Entity Type:Individual
Prefix:MS
First Name:HARRIET
Middle Name:PHYLLIS
Last Name:KAZANSKY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:HARRIET
Other - Middle Name:PHYLLIS
Other - Last Name:SASS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW-R
Mailing Address - Street 1:4 HAZELTINE LN
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08527-4045
Mailing Address - Country:US
Mailing Address - Phone:917-838-3562
Mailing Address - Fax:
Practice Address - Street 1:4 HAZELTINE LN
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:NJ
Practice Address - Zip Code:08527-4045
Practice Address - Country:US
Practice Address - Phone:917-838-3562
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-03
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC057886001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYR045061-1OtherCLINICAL SOCIAL WORK LICENSE