Provider Demographics
NPI:1093870040
Name:PONTICELLO, JOSEPHINE (MSW LCSW)
Entity Type:Individual
Prefix:
First Name:JOSEPHINE
Middle Name:
Last Name:PONTICELLO
Suffix:
Gender:F
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 ERNST AVE
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-4508
Mailing Address - Country:US
Mailing Address - Phone:973-338-6744
Mailing Address - Fax:973-338-6589
Practice Address - Street 1:3 ERNST AVE
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07003-4508
Practice Address - Country:US
Practice Address - Phone:973-338-6744
Practice Address - Fax:973-338-6589
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJSC020371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical