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General NPI Number Information
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NPI Number | 1780963868
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Entity Type | Individual
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Provider Name | JACQUELINE THOMAS LCSW
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Gender | Female
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Dates
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Enumeration Date | 08/08/2011
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Last Update Date | 10/12/2018
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Provider Practice Location Address
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Address Line | 774 EAYRESTOWN ROAD
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City | LUMBERTON
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State | NJ
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Zip | 08048-3100
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Country | US
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Telephone | 917-868-2113
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Fax | 856-216-7565
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Provider Business Mailing Address
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Address Line | 774 EAYRESTOWN ROAD
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City | LUMBERTON
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State | NJ
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Zip | 08048-3100
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Country | US
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Telephone | 917-868-2113
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Fax | 610-644-4066
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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 | 44SC05425200
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License Number State | NJ
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