Healthcare Provider Details

I. General information

NPI: 1285236943
Provider Name (Legal Business Name): JOAN BANKOLE-JONES MSW, LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2020
Last Update Date: 11/09/2020
Certification Date: 11/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

935 PARK AVE
PLAINFIELD NJ
07060-3001
US

IV. Provider business mailing address

59 FAIRFIELD AVE
LAWRENCEVILLE NJ
08648-4305
US

V. Phone/Fax

Practice location:
  • Phone: 908-312-3232
  • Fax:
Mailing address:
  • Phone: 732-629-0394
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number44SL06236600
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: