Healthcare Provider Details

I. General information

NPI: 1891969515
Provider Name (Legal Business Name): JEROME FOSTER LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2008
Last Update Date: 04/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1270 KINGS HWY
LEWES DE
19958-1735
US

IV. Provider business mailing address

1270 KINGS HWY
LEWES DE
19958-1735
US

V. Phone/Fax

Practice location:
  • Phone: 302-645-6686
  • Fax: 302-684-8931
Mailing address:
  • Phone: 302-645-6686
  • Fax: 302-684-8931

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberQ10000928
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: