1780879452 NPI number — MRS. JEANNETTE MARIE GAGLIARDI LCSW

Table of content: MRS. JEANNETTE MARIE GAGLIARDI LCSW (NPI 1780879452)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780879452 NPI number — MRS. JEANNETTE MARIE GAGLIARDI LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GAGLIARDI
Provider First Name:
JEANNETTE
Provider Middle Name:
MARIE
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:
CRAIG
Provider Other First Name:
JEANNETTE
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1780879452
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/09/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
123 EGG HARBOR RD STE 202
Provider Second Line Business Mailing Address:
TOWER COMMONS OFFICE COMPLEX, BUILDING 200
Provider Business Mailing Address City Name:
SEWELL
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08080-9406
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-347-0445
Provider Business Mailing Address Fax Number:
856-228-1096

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
123 EGG HARBOR RD
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
SEWELL
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08080-9406
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-347-0445
Provider Business Practice Location Address Fax Number:
856-228-1096
Provider Enumeration Date:
09/06/2007

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:  44SC05332100 , 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)





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