Provider Demographics
NPI:1669962726
Name:KUSHNIR, KARA NICOLE (LCSW)
Entity type:Individual
Prefix:
First Name:KARA
Middle Name:NICOLE
Last Name:KUSHNIR
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KARA
Other - Middle Name:NICOLE
Other - Last Name:SELLIX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:1007 THOREAU CT
Mailing Address - Street 2:
Mailing Address - City:MAHWAH
Mailing Address - State:NJ
Mailing Address - Zip Code:07430-2393
Mailing Address - Country:US
Mailing Address - Phone:973-865-9699
Mailing Address - Fax:
Practice Address - Street 1:1 DE MERCURIO DR STE 2A
Practice Address - Street 2:
Practice Address - City:ALLENDALE
Practice Address - State:NJ
Practice Address - Zip Code:07401-1737
Practice Address - Country:US
Practice Address - Phone:862-283-0828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-15
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC057840001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical