Healthcare Provider Details

I. General information

NPI: 1982624904
Provider Name (Legal Business Name): JOLEEN ANNE BENEDICT LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 HAMILTON AVE
HAMILTON NJ
08619-3007
US

IV. Provider business mailing address

411 GARNET DR
BURLINGTON NJ
08016-4711
US

V. Phone/Fax

Practice location:
  • Phone: 609-587-7044
  • Fax:
Mailing address:
  • Phone: 609-386-2210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC00038400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: