Provider Demographics
NPI:1902882491
Name:KASSICK, KEVIN (LPC, LCADC)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:
Last Name:KASSICK
Suffix:
Gender:M
Credentials:LPC, LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 ROSEBERRY ST
Mailing Address - Street 2:SUITE 8
Mailing Address - City:PHILLIPSBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:08865-1600
Mailing Address - Country:US
Mailing Address - Phone:908-454-7244
Mailing Address - Fax:908-859-2109
Practice Address - Street 1:305 ROSEBERRY ST
Practice Address - Street 2:SUITE 8
Practice Address - City:PHILLIPSBURG
Practice Address - State:NJ
Practice Address - Zip Code:08865-1600
Practice Address - Country:US
Practice Address - Phone:908-454-7244
Practice Address - Fax:908-859-2109
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00056808101YA0400X
NJ37PC00042400101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP3440976OtherOXFORD