=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811074552
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOSEFINA MORALES-JIMENEZ MSW,LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/01/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1160 RAYMOND BLVD 6TH FLOOR
-----------------------------------------------------
City | NEWARK
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07102-4168
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-639-6520
-----------------------------------------------------
Fax | 973-642-2501
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 721 PAGE AVE
-----------------------------------------------------
City | LYNDHURST
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07071-2516
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-681-5930
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
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 | 44SC05252800
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------