Healthcare Provider Details

I. General information

NPI: 1730637893
Provider Name (Legal Business Name): JACQUELINE POWELL LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2016
Last Update Date: 01/12/2026
Certification Date: 01/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 WARREN ST STE 23
HACKENSACK NJ
07601-5436
US

IV. Provider business mailing address

15 WARREN ST STE 23
HACKENSACK NJ
07601-5436
US

V. Phone/Fax

Practice location:
  • Phone: 201-205-1131
  • Fax:
Mailing address:
  • Phone: 201-205-1131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC05885100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: