Provider Demographics
NPI:1053568907
Name:KOLSKY, BEVERLY ANNE (MSW, LCSW, BCD-P)
Entity type:Individual
Prefix:MRS
First Name:BEVERLY
Middle Name:ANNE
Last Name:KOLSKY
Suffix:
Gender:F
Credentials:MSW, LCSW, BCD-P
Other - Prefix:MS
Other - First Name:BEVERLY
Other - Middle Name:ANNE
Other - Last Name:COHEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LCSW
Mailing Address - Street 1:163 ENGLE ST.
Mailing Address - Street 2:BLDG 5
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631
Mailing Address - Country:US
Mailing Address - Phone:201-894-5499
Mailing Address - Fax:201-692-9219
Practice Address - Street 1:163 ENGLE ST.
Practice Address - Street 2:BLDG 5
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631
Practice Address - Country:US
Practice Address - Phone:201-894-5499
Practice Address - Fax:201-692-9219
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-22
Last Update Date:2008-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC00196100102L00000X
104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
$$$$$$$$$TMedicare UPIN