Provider Demographics
NPI:1629793294
Name:JANDZIO, THEA (LCSW)
Entity Type:Individual
Prefix:
First Name:THEA
Middle Name:
Last Name:JANDZIO
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 1:137 E BERGEN PL
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-2110
Mailing Address - Country:US
Mailing Address - Phone:347-430-3292
Mailing Address - Fax:
Practice Address - Street 1:137 E BERGEN PL
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-2110
Practice Address - Country:US
Practice Address - Phone:347-430-3292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-06
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY082780-011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical