Provider Demographics
NPI:1679686315
Name:JACKSON, CYNTHIA LERAY (LCSW)
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:LERAY
Last Name:JACKSON
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 1:95 MT. KEMBLE AVENUE
Mailing Address - Street 2:ATTN: C.LAMPRON
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07962-1978
Mailing Address - Country:US
Mailing Address - Phone:973-971-4714
Mailing Address - Fax:973-290-7585
Practice Address - Street 1:200 SOUTH ST
Practice Address - Street 2:CONCERN SUITE 402
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-5370
Practice Address - Country:US
Practice Address - Phone:800-242-7371
Practice Address - Fax:973-451-0482
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC010255001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical