1003230392 NPI number — MS. YUDELKA COLUMNA-GRAJEWSKI LCSW, MSW

Table of content: MS. YUDELKA COLUMNA-GRAJEWSKI LCSW, MSW (NPI 1003230392)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003230392 NPI number — MS. YUDELKA COLUMNA-GRAJEWSKI LCSW, MSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COLUMNA-GRAJEWSKI
Provider First Name:
YUDELKA
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW, MSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
COLUMNA-CORDERO, COLUMNA-GUZMAN
Provider Other First Name:
YUDELKA
Provider Other Middle Name:
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1003230392
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/04/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
50 SOUTH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ANDOVER
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07821-5503
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-710-6875
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 MOUNTAIN CT STE 101B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HACKETTSTOWN
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07840-2300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
908-620-6336
Provider Business Practice Location Address Fax Number:
844-236-1502
Provider Enumeration Date:
02/07/2014

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  44SC05843800 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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