Healthcare Provider Details

I. General information

NPI: 1710063326
Provider Name (Legal Business Name): BARBARA O'HANLON MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1160 RAYMOND BLVD
NEWARK NJ
07102-4168
US

IV. Provider business mailing address

76 SWEET BRIAR DR APT 18
CLARK NJ
07066-2024
US

V. Phone/Fax

Practice location:
  • Phone: 973-596-4112
  • Fax: 973-642-2501
Mailing address:
  • Phone: 732-382-6606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC05254400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: