Healthcare Provider Details

I. General information

NPI: 1285227827
Provider Name (Legal Business Name): NEREA JAYO-SCHIELKE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2021
Last Update Date: 02/15/2021
Certification Date: 01/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1581 NJ-23 #2
WAYNE NJ
07470
US

IV. Provider business mailing address

1581 NJ-23 #2
WAYNE NJ
07470
US

V. Phone/Fax

Practice location:
  • Phone: 973-932-0881
  • Fax: 201-595-0290
Mailing address:
  • Phone: 973-932-0881
  • Fax: 201-595-0290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: NEREA JAYO-SCHIELKE
Title or Position: L.C.S.W
Credential: L.C.S.W
Phone: 973-932-0881