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General NPI Number Information
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NPI Number | 1568636504
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Entity Type | Organization
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Legal Business Name | RANDI E. JEDDIS, MSW,LCSW,LLC
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Dates
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Enumeration Date | 04/22/2008
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Last Update Date | 04/22/2008
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Provider Practice Location Address
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Address Line | 6 POMPTON AVE SUITE #24
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City | CEDAR GROVE
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State | NJ
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Zip | 07009-2042
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Country | US
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Telephone | 973-239-3373
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Fax |
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Provider Business Mailing Address
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Address Line | 6 POMPTON AVE SUITE #24
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City | CEDAR GROVE
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State | NJ
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Zip | 07009-2042
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Country | US
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Telephone | 973-239-3373
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Fax |
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Authorized Official
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Title or Position | PSYCHOTHERAPIST
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Name | MS. RANDI ELLEN JEDDIS
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Credential | MSW,LCSW
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Telephone | 973-239-3373
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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 | 44SC00172600
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License Number State | NJ
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