Provider Demographics
NPI:1508074881
Name:JONES, ROSA D (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ROSA
Middle Name:D
Last Name:JONES
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 1:1137 AVENUE C
Mailing Address - Street 2:
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-3313
Mailing Address - Country:US
Mailing Address - Phone:201-339-3371
Mailing Address - Fax:201-339-3376
Practice Address - Street 1:1137 AVENUE C
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-3313
Practice Address - Country:US
Practice Address - Phone:201-339-3371
Practice Address - Fax:201-339-3376
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC052075001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ098424Medicare ID - Type Unspecified