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General NPI Number Information
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NPI Number | 1528611183
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Entity Type | Individual
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Provider Name | JOSEPH PAUL PSOMAS-JACKLOSKI MSW, LCSW, LCADC
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Gender | Male
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Dates
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Enumeration Date | 07/22/2019
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Last Update Date | 07/22/2019
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Provider Practice Location Address
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Address Line | 99 BEAUVOIR AVE
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City | SUMMIT
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State | NJ
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Zip | 07901-3533
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Country | US
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Telephone | 973-255-6047
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Fax |
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Provider Business Mailing Address
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Address Line | 211 SHUNPIKE RD
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City | CHATHAM
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State | NJ
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Zip | 07928-1817
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Country | US
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Telephone | 973-635-8950
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 44SC05182600
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License Number State | NJ
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