Provider Demographics
NPI:1427187475
Name:SLOVAK, JENNIFER EASTON (MSW LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:EASTON
Last Name:SLOVAK
Suffix:
Gender:F
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:712 WALL ROAD
Mailing Address - Street 2:
Mailing Address - City:SPRING LAKE HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:07762
Mailing Address - Country:US
Mailing Address - Phone:732-449-6560
Mailing Address - Fax:732-449-6560
Practice Address - Street 1:712 WALL ROAD
Practice Address - Street 2:
Practice Address - City:SPRING LAKE HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:07762
Practice Address - Country:US
Practice Address - Phone:732-449-6560
Practice Address - Fax:732-449-6560
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC00757700104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
014062Medicare ID - Type Unspecified