Provider Demographics
NPI:1063680205
Name:MARIS, JANINE M (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JANINE
Middle Name:M
Last Name:MARIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 WOODPORT RD
Mailing Address - Street 2:UNIT B
Mailing Address - City:SPARTA
Mailing Address - State:NJ
Mailing Address - Zip Code:07871-2628
Mailing Address - Country:US
Mailing Address - Phone:973-726-3772
Mailing Address - Fax:973-726-3775
Practice Address - Street 1:200 WOODPORT RD
Practice Address - Street 2:UNIT B
Practice Address - City:SPARTA
Practice Address - State:NJ
Practice Address - Zip Code:07871-2628
Practice Address - Country:US
Practice Address - Phone:973-726-3772
Practice Address - Fax:973-726-3775
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-11
Last Update Date:2015-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC05214800101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ141501ZCGGMedicare PIN