Provider Demographics
NPI:1154089878
Name:JORGE, EULOIZA (LCSW)
Entity Type:Individual
Prefix:
First Name:EULOIZA
Middle Name:
Last Name:JORGE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ELOIZA
Other - Middle Name:
Other - Last Name:JORGE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:49 PARK ST
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-3439
Mailing Address - Country:US
Mailing Address - Phone:973-223-9983
Mailing Address - Fax:
Practice Address - Street 1:49 PARK ST
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-3439
Practice Address - Country:US
Practice Address - Phone:973-223-9983
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-30
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC2000016741041C0700X
NJ44SC060456001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical