MEDICARE: MRS. MEGAN JEROME LSW

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	104100000X	Social Worker	44SL05984900	NJ

General Provider Information

NPI Number	:	1487011482
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MEGAN JEROME LSW

Provider Business Mailing Address
First Line	:	13 STONE CLIFF TER
Second Line	:
City	:	OAK RIDGE
State	:	NJ
Zip	:	07438-8896
Country	:	US
Telephone Number	:	973-940-0105
Fax Number	:	973-940-0304

Provider Business Practice Location Address
First Line	:	376 LAFAYETTE RD
Second Line	:
City	:	SPARTA
State	:	NJ
Zip	:	07871-3560
Country	:	US
Telephone Number	:	973-940-0105
Fax Number	:	973-940-0304

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

Provider Enumeration Date	:	01/21/2016
Last Update Date	:	01/21/2016

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