1700053840 NPI number — MRS. JOAN AUDREY GALKIN LCSW

Table of content: MRS. JOAN AUDREY GALKIN LCSW (NPI 1700053840)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700053840 NPI number — MRS. JOAN AUDREY GALKIN LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GALKIN
Provider First Name:
JOAN
Provider Middle Name:
AUDREY
Provider Name Prefix Text:
MRS.
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:
FALLR
Provider Other First Name:
JOAN
Provider Other Middle Name:
AUDREY
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1700053840
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/23/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
905 HERRONTOWN ROAD
Provider Second Line Business Mailing Address:
PRINCETON HOUSE
Provider Business Mailing Address City Name:
PRINCETON
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08540
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
609-688-3719
Provider Business Mailing Address Fax Number:
609-497-2676

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4 PRINCESS RD STE 206
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAWRENCEVILLE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08648-2322
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-482-8049
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/08/2008

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:  SC45148 , 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)