=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992200661
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MAUREEN REILLY PAPKE
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/26/2018
-----------------------------------------------------
Last Update Date | 03/26/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14 ESTAUGH AVE
-----------------------------------------------------
City | BERLIN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08009-1414
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-767-3700
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 801 W PARK AVE APT 25D
-----------------------------------------------------
City | LINDENWOLD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08021-3638
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-872-6259
-----------------------------------------------------
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 | 44SC05765700
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------