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General NPI Number Information
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NPI Number | 1326588690
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Entity Type | Individual
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Provider Name | JARED RANDIEK LSW
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Gender | Male
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Dates
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Enumeration Date | 03/06/2017
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Last Update Date | 03/06/2017
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Provider Practice Location Address
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Address Line | 221 LAUREL RD
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City | VOORHEES
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State | NJ
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Zip | 08043-2330
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Country | US
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Telephone | 856-772-5809
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Fax |
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Provider Business Mailing Address
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Address Line | 228 HAMILTON RD
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City | MARLTON
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State | NJ
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Zip | 08053-1264
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Country | US
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Telephone | 856-883-0061
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 44SL05569100
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License Number State | NJ
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