Provider Demographics
NPI:1275225393
Name:PATEL, GUNJAN (ACSW)
Entity Type:Individual
Prefix:
First Name:GUNJAN
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:292 FOUNTAYNE LN
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08648-2677
Mailing Address - Country:US
Mailing Address - Phone:609-786-0860
Mailing Address - Fax:
Practice Address - Street 1:292 FOUNTAYNE LN
Practice Address - Street 2:
Practice Address - City:LAWRENCE TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08648-2677
Practice Address - Country:US
Practice Address - Phone:609-786-0860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-25
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ10735071041S0200X
NJ104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool