Provider Demographics
NPI:1659014553
Name:MILKAMP, JULISSA (LSW)
Entity Type:Individual
Prefix:
First Name:JULISSA
Middle Name:
Last Name:MILKAMP
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 MANDON TER
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07506-3206
Mailing Address - Country:US
Mailing Address - Phone:201-681-8944
Mailing Address - Fax:
Practice Address - Street 1:114 KINDERKAMACK RD
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07656-2126
Practice Address - Country:US
Practice Address - Phone:201-391-1355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-18
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06019200104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ44SL06019200OtherTHE NEW JERSEY BOARD OF SOCIAL WORK EXAMINERS