Provider Demographics
NPI:1447018494
Name:GORELICK, ADINA
Entity type:Individual
Prefix:
First Name:ADINA
Middle Name:
Last Name:GORELICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ADINA
Other - Middle Name:AIDEL
Other - Last Name:KESSLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:89 EDGECOMB AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-6154
Mailing Address - Country:US
Mailing Address - Phone:732-962-0620
Mailing Address - Fax:
Practice Address - Street 1:89 EDGECOMB AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-6154
Practice Address - Country:US
Practice Address - Phone:732-962-0620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-13
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1-24-71797103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst