Provider Demographics
NPI:1578614053
Name:FIRSICHBAUM, JEFF (MSW)
Entity Type:Individual
Prefix:MR
First Name:JEFF
Middle Name:
Last Name:FIRSICHBAUM
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1451 ROUTE 88
Mailing Address - Street 2:SUITE 4A
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724-2371
Mailing Address - Country:US
Mailing Address - Phone:732-785-2744
Mailing Address - Fax:732-901-8601
Practice Address - Street 1:1451 ROUTE 88
Practice Address - Street 2:SUITE 4A
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724-2371
Practice Address - Country:US
Practice Address - Phone:732-785-2744
Practice Address - Fax:732-901-8601
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00076400101YA0400X
NJ44SC008776001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ638782Medicare ID - Type Unspecified
NJ599385Medicare UPIN