1073522165 NPI number — CHERYL JONES-HOLADAY LCSW

Table of content: CHERYL JONES-HOLADAY LCSW (NPI 1073522165)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073522165 NPI number — CHERYL JONES-HOLADAY LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JONES-HOLADAY
Provider First Name:
CHERYL
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073522165
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/14/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
770 EAST MAIN STREET
Provider Second Line Business Mailing Address:
SUITE 1A
Provider Business Mailing Address City Name:
MOORESTOWN
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08057-3040
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-234-0470
Provider Business Mailing Address Fax Number:
856-722-0564

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
770E MAIN ST 1A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOORESTOWN
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08057
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-234-0470
Provider Business Practice Location Address Fax Number:
856-722-0564
Provider Enumeration Date:
08/07/2006

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:  44SC00365500 , 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)

  • Identifier: 458444000 . This is a "MAGELLAN MIS NUMBER" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: P00267666 . This is a "RAILROAD MEDICARE NUMBER" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 7589086 . This is a "AETNA PIN NUMBER" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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