Provider Demographics
NPI:1659781953
Name:WINKLER, JACOB (LCSW, CGP, CAMS-II)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:
Last Name:WINKLER
Suffix:
Gender:M
Credentials:LCSW, CGP, CAMS-II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 RARITAN AVE STE 304A
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08904-2752
Mailing Address - Country:US
Mailing Address - Phone:804-404-5679
Mailing Address - Fax:
Practice Address - Street 1:320 RARITAN AVE STE 304A
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:08904-2752
Practice Address - Country:US
Practice Address - Phone:804-404-5679
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-07
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0865361041C0700X
NJ44SC057418001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical