MEDICARE: MS. JANINE M MARIS LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	44SC05214800	NJ

General Provider Information

NPI Number	:	1063680205
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JANINE M MARIS LCSW

Provider Business Mailing Address
First Line	:	200 WOODPORT RD
Second Line	:	UNIT B
City	:	SPARTA
State	:	NJ
Zip	:	07871-2628
Country	:	US
Telephone Number	:	973-726-3772
Fax Number	:	973-726-3775

Provider Business Practice Location Address
First Line	:	200 WOODPORT RD
Second Line	:	UNIT B
City	:	SPARTA
State	:	NJ
Zip	:	07871-2628
Country	:	US
Telephone Number	:	973-726-3772
Fax Number	:	973-726-3775

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/11/2008
Last Update Date	:	04/15/2026

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