Provider Demographics
NPI:1508597063
Name:JEROME HALL, LISW-CP
Entity Type:Organization
Organization Name:JEROME HALL, LISW-CP
Other - Org Name:JEROME HALL, LISW-CP
Other - Org Type:Other Name
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-984-9031
Mailing Address - Street 1:454 ANDERSON RD S STE 214
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29730-3398
Mailing Address - Country:US
Mailing Address - Phone:704-771-2976
Mailing Address - Fax:
Practice Address - Street 1:454 ANDERSON RD S STE 214
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29730-3398
Practice Address - Country:US
Practice Address - Phone:047-712-9767
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-23
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty