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General NPI Number Information
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NPI Number | 1508307208
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Entity Type | Organization
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Legal Business Name | ROBERT D. JENKINS, LCSW, CSOTS, CCS, LLC
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Dates
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Enumeration Date | 03/14/2017
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Last Update Date | 03/14/2017
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Provider Practice Location Address
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Address Line | 134 LINWOOD TER
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City | CLIFTON
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State | NJ
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Zip | 07012-2335
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Country | US
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Telephone | 973-204-3793
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Fax |
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Provider Business Mailing Address
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Address Line | 466 KINDERKAMACK RD
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City | ORADELL
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State | NJ
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Zip | 07649-1536
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Country | US
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Telephone | 973-204-3793
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Fax |
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Authorized Official
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Title or Position | PRINCIPLE
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Name | MR. ROBERT DAVID JENKINS
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Credential | LCSW, CSOTS, CCS
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Telephone | 973-204-3793
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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 | 44SC04971700
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License Number State | NJ
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