1689886434 NPI number — MRS. JOAN R SICHERMAN MSW LCSW

Table of content: MRS. JOAN R SICHERMAN MSW LCSW (NPI 1689886434)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689886434 NPI number — MRS. JOAN R SICHERMAN MSW LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SICHERMAN
Provider First Name:
JOAN
Provider Middle Name:
R
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MSW LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SICHERMAN
Provider Other First Name:
JOAN
Provider Other Middle Name:
FANE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSW LCSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1689886434
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
152 N MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CRANBURY
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08512
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
609-655-4151
Provider Business Mailing Address Fax Number:
609-395-8498

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
152 N MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CRANBURY
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08512
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-655-4151
Provider Business Practice Location Address Fax Number:
609-395-8498
Provider Enumeration Date:
05/04/2007

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:  NJSC04800 , 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: 145435 . This is a "VALUE OPTIONS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".