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NPI Code Detail

MEDICARE: MRS. JACQULINE DELANE PHILLIPS MSW, LCSW

MEDICARE: MRS. JACQULINE DELANE PHILLIPS MSW, 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
11041C0700XClinical Social WorkerSC04516NJ

General Provider Information

NPI Number : 1417262577
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JACQULINE DELANE PHILLIPS MSW, LCSW
Provider Business Mailing Address
First Line : 328 DENISON ST
Second Line :
City : HIGHLAND PARK
State : NJ
Zip : 08904-2732
Country : US
Telephone Number : 732-248-7782
Fax Number :
Provider Business Practice Location Address
First Line : 328 DENISON ST
Second Line :
City : HIGHLAND PARK
State : NJ
Zip : 08904-2732
Country : US
Telephone Number : 732-248-7782
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/13/2010
Last Update Date : 08/13/2010

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