Healthcare Provider Details

I. General information

NPI: 1043456882
Provider Name (Legal Business Name): CHERYL JOAN SOLOMON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2008
Last Update Date: 12/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 FORD AVE 2ND FLOOR
MILLTOWN NJ
08850
US

IV. Provider business mailing address

32 FORD AVE 2ND FLOOR
MILLTOWN NJ
08850-1532
US

V. Phone/Fax

Practice location:
  • Phone: 609-395-7979
  • Fax: 609-395-7129
Mailing address:
  • Phone: 732-777-1940
  • Fax: 732-777-1889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number44SC00387300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: