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General NPI Number Information
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NPI Number | 1134593122
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Entity Type | Organization
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Legal Business Name | JACQUELINE STADLER, LCSW, LLC
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Dates
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Enumeration Date | 11/14/2015
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Last Update Date | 11/14/2015
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Provider Practice Location Address
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Address Line | 87 W END AVE
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City | SOMERVILLE
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State | NJ
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Zip | 08876-1828
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Country | US
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Telephone | 908-547-0620
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Fax |
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Provider Business Mailing Address
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Address Line | 715 MADISON AVE
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City | DUNELLEN
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State | NJ
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Zip | 08812-1109
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Country | US
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Telephone | 908-227-5318
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Fax |
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Authorized Official
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Title or Position | OWNER-LCSW
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Name | MRS. JACQUELINE S STADLER
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Credential | LCSW
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Telephone | 908-227-5318
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 44SC05320800
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License Number State | NJ
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