Provider Demographics
NPI:1306041512
Name:JAKES, SHARON D (LCSW)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:D
Last Name:JAKES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:655 E JERSEY ST
Mailing Address - Street 2:DEPT. BEHAVIROAL HEALTH & PSYCHIARTY
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07206-1259
Mailing Address - Country:US
Mailing Address - Phone:908-994-5000
Mailing Address - Fax:908-994-5000
Practice Address - Street 1:655 E JERSEY ST
Practice Address - Street 2:DEPT. BEHAVIROAL HEALTH & PSYCHIARTY
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07206-1259
Practice Address - Country:US
Practice Address - Phone:908-994-5000
Practice Address - Fax:908-994-5000
Is Sole Proprietor?:No
Enumeration Date:2007-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL052585001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ44SL05258500OtherSTATE LICESNE