Healthcare Provider Details

I. General information

NPI: 1821755711
Provider Name (Legal Business Name): JACQUELINE COLLARD DSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/26/2021
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

88 W RIDGEWOOD AVE
RIDGEWOOD NJ
07450-3199
US

IV. Provider business mailing address

578 MAYWOOD AVE APT 1A
MAYWOOD NJ
07607-1560
US

V. Phone/Fax

Practice location:
  • Phone: 201-714-0820
  • Fax:
Mailing address:
  • Phone: 908-721-6728
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC06419800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: