Healthcare Provider Details

I. General information

NPI: 1639647837
Provider Name (Legal Business Name): JESSICA GRACE THALHAMER DC, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2018
Last Update Date: 10/27/2025
Certification Date: 10/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 UNIVERSITY PLZ STE 100
HACKENSACK NJ
07601-6210
US

IV. Provider business mailing address

2 UNIVERSITY PLZ STE 100
HACKENSACK NJ
07601-6210
US

V. Phone/Fax

Practice location:
  • Phone: 631-834-8647
  • Fax:
Mailing address:
  • Phone: 631-834-8647
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number12313-C
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number14334
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2371289
License Number StateID
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC06423900
License Number StateNJ
# 5
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC24034
License Number StateME
# 6
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number013113
License Number StateNY
# 7
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number14251829-3501
License Number StateUT
# 8
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number097116
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: