Healthcare Provider Details

I. General information

NPI: 1922247337
Provider Name (Legal Business Name): JAIME L KAZMARCK LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2009
Last Update Date: 02/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

608 N JEROME AVE
MARGATE CITY NJ
08402-1528
US

IV. Provider business mailing address

608 N JEROME AVE
MARGATE CITY NJ
08402-1528
US

V. Phone/Fax

Practice location:
  • Phone: 609-822-1108
  • Fax: 609-822-1106
Mailing address:
  • Phone: 609-822-1108
  • Fax: 609-822-1106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC05381500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: