Provider Demographics
NPI:1275311953
Name:ELIOPOULOS, JEREMY HAYES (LSW)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:HAYES
Last Name:ELIOPOULOS
Suffix:
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:848 BERKSHIRE RD
Mailing Address - Street 2:
Mailing Address - City:RIVER VALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07675-6603
Mailing Address - Country:US
Mailing Address - Phone:201-870-2930
Mailing Address - Fax:
Practice Address - Street 1:58 N SUSSEX ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NJ
Practice Address - Zip Code:07801-4259
Practice Address - Country:US
Practice Address - Phone:609-256-6380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-15
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL069968001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical