Healthcare Provider Details

I. General information

NPI: 1790057875
Provider Name (Legal Business Name): NEREA JAYO-SCHIELKE L.C.S.W
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2012
Last Update Date: 03/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 MAIN ST
HACKENSACK NJ
07601-7015
US

IV. Provider business mailing address

1581 ROUTE 23 SUITE 2
WAYNE NJ
07470-7508
US

V. Phone/Fax

Practice location:
  • Phone: 973-932-0881
  • Fax:
Mailing address:
  • Phone: 973-932-0881
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC05291100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: