Healthcare Provider Details

I. General information

NPI: 1992932701
Provider Name (Legal Business Name): BETH A CIPOLETTI LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2009
Last Update Date: 06/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 GODWIN AVE
MIDLAND PARK NJ
07432-1519
US

IV. Provider business mailing address

12 CONCORD RD APT F
WEST MILFORD NJ
07480-1272
US

V. Phone/Fax

Practice location:
  • Phone: 973-493-9116
  • Fax:
Mailing address:
  • Phone: 973-493-9116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC05383900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: