Provider Demographics
NPI:1326199373
Name:JALKIEWICZ, LORI MICHELE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:MICHELE
Last Name:JALKIEWICZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:LORI
Other - Middle Name:MICHELE
Other - Last Name:NEILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:42 DELSEA DR S
Mailing Address - Street 2:
Mailing Address - City:GLASSBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08028-2621
Mailing Address - Country:US
Mailing Address - Phone:856-863-0006
Mailing Address - Fax:856-881-7614
Practice Address - Street 1:42 DELSEA DR S
Practice Address - Street 2:
Practice Address - City:GLASSBORO
Practice Address - State:NJ
Practice Address - Zip Code:08028-2621
Practice Address - Country:US
Practice Address - Phone:856-863-0006
Practice Address - Fax:856-881-7614
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC052644001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ803771000OtherMAGELLAN
NJ2456568000OtherAMERIHEALTH