Healthcare Provider Details

I. General information

NPI: 1730319294
Provider Name (Legal Business Name): JOLANTA SZMUC LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2009
Last Update Date: 11/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 HAMBURG TPKE SUITE 2B
WAYNE NJ
07470-8480
US

IV. Provider business mailing address

450 HAMBURG TPKE SUITE 2B
WAYNE NJ
07470-8480
US

V. Phone/Fax

Practice location:
  • Phone: 973-800-7123
  • Fax: 973-521-8561
Mailing address:
  • Phone: 973-800-7123
  • Fax: 973-521-8561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37PC00390100
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number37LC00161900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: