MEDICARE: JANET LICHAUCO LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	44SC00837400	NJ

General Provider Information

NPI Number	:	1790919975
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANET LICHAUCO LCSW

Provider Business Mailing Address
First Line	:	259 NEW BRUNSWICK AVE STE 202
Second Line	:
City	:	FORDS
State	:	NJ
Zip	:	08863-2260
Country	:	US
Telephone Number	:	732-259-9603
Fax Number	:	732-243-9074

Provider Business Practice Location Address
First Line	:	259 NEW BRUNSWICK AVE STE 202
Second Line	:
City	:	FORDS
State	:	NJ
Zip	:	08863-2260
Country	:	US
Telephone Number	:	732-259-9603
Fax Number	:	732-243-9074

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2009
Last Update Date	:	03/18/2025

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