Provider Demographics
NPI:1619684495
Name:CASWELL, JACOB ROBERT (MSW)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:ROBERT
Last Name:CASWELL
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 1:725 BERMUDA DR
Mailing Address - Street 2:
Mailing Address - City:BRANCHBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:08853-4275
Mailing Address - Country:US
Mailing Address - Phone:908-801-2208
Mailing Address - Fax:
Practice Address - Street 1:7 DRYDOCK AVE
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02210-2303
Practice Address - Country:US
Practice Address - Phone:857-203-6461
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-01
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06821500104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker