1700040839 NPI number — JACQUELINE M PLANT LSW

Table of content: JACQUELINE M PLANT LSW (NPI 1700040839)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700040839 NPI number — JACQUELINE M PLANT LSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PLANT
Provider First Name:
JACQUELINE
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MAIZELL
Provider Other First Name:
JACQUELINE
Provider Other Middle Name:
M
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1700040839
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/19/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
904 RIDGE ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWTON
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07860
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
492 ROUTE 57 WEST
Provider Second Line Business Practice Location Address:
FAMILY GUIDANCE CENTER OF WARREN MAIN OFFICE
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07882-1420
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
908-689-1000
Provider Business Practice Location Address Fax Number:
908-689-4529
Provider Enumeration Date:
07/17/2008

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: 104100000X , with the licence number:  44SL05204400 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: 44SC05472600 , 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)