=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457592313
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JILL BARNETT KAUFMAN LSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/23/2009
-----------------------------------------------------
Last Update Date | 10/28/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 707 ALEXANDER RD STE 102
-----------------------------------------------------
City | PRINCETON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08540-6331
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-987-8100
-----------------------------------------------------
Fax | 609-987-0574
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 50 FISHER AVENUE
-----------------------------------------------------
City | PRINCETON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08540
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-400-2888
-----------------------------------------------------
Fax | 877-343-6657
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 44SC05416900
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------