Provider Demographics
NPI:1194410779
Name:MALLIK, VASWATI (LCSW)
Entity type:Individual
Prefix:
First Name:VASWATI
Middle Name:
Last Name:MALLIK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 DITZEL FARM RD
Mailing Address - Street 2:
Mailing Address - City:SCOTCH PLAINS
Mailing Address - State:NJ
Mailing Address - Zip Code:07076-2946
Mailing Address - Country:US
Mailing Address - Phone:267-848-9622
Mailing Address - Fax:
Practice Address - Street 1:4 DITZEL FARM RD
Practice Address - Street 2:
Practice Address - City:SCOTCH PLAINS
Practice Address - State:NJ
Practice Address - Zip Code:07076-2946
Practice Address - Country:US
Practice Address - Phone:908-938-5388
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-10
Last Update Date:2024-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC063118001041C0700X
MELC239141041C0700X
NY0954981041C0700X
DEQ1-00124611041C0700X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical