Healthcare Provider Details

I. General information

NPI: 1427672930
Provider Name (Legal Business Name): JEANNE MCLAUGHLINPOLASKY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2020
Last Update Date: 06/01/2020
Certification Date: 06/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 W 7TH ST
PLAINFIELD NJ
07060-1511
US

IV. Provider business mailing address

367 FOREST DR
UNION NJ
07083-7964
US

V. Phone/Fax

Practice location:
  • Phone: 908-755-4848
  • Fax: 908-755-3655
Mailing address:
  • Phone: 908-477-8686
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC00486200
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: