Provider Demographics
NPI:1659726834
Name:AVILES, JEFFREY (LCSW)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:AVILES
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 EASTERN AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224-4010
Mailing Address - Country:US
Mailing Address - Phone:201-920-6787
Mailing Address - Fax:
Practice Address - Street 1:198 NORTH AVE E
Practice Address - Street 2:
Practice Address - City:CRANFORD
Practice Address - State:NJ
Practice Address - Zip Code:07016-2469
Practice Address - Country:US
Practice Address - Phone:201-920-6787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-26
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD222991041C0700X
NJ44SC056850001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical