Provider Demographics
NPI:1114178977
Name:JANINE MARIS LCSW, LLC
Entity Type:Organization
Organization Name:JANINE MARIS LCSW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JANINE
Authorized Official - Middle Name:
Authorized Official - Last Name:MARIS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:973-300-4110
Mailing Address - Street 1:PO BOX 658
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:NJ
Mailing Address - Zip Code:07822-0658
Mailing Address - Country:US
Mailing Address - Phone:973-300-4110
Mailing Address - Fax:973-579-9007
Practice Address - Street 1:93 MAIN ST
Practice Address - Street 2:SUITE 300
Practice Address - City:NEWTON
Practice Address - State:NJ
Practice Address - Zip Code:07860-2056
Practice Address - Country:US
Practice Address - Phone:973-300-4110
Practice Address - Fax:973-579-9007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-09
Last Update Date:2009-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC052148001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ44SC05214800OtherSTATE LICENSE
NJ44SC05214800OtherSTATE LICENSE