Provider Demographics
NPI:1710426382
Name:ATKINS, GERALDINE (MSW, ABD)
Entity Type:Individual
Prefix:PROF
First Name:GERALDINE
Middle Name:
Last Name:ATKINS
Suffix:
Gender:F
Credentials:MSW, ABD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 LIBERTY DR
Mailing Address - Street 2:
Mailing Address - City:SOMERDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:08083-2007
Mailing Address - Country:US
Mailing Address - Phone:856-325-0944
Mailing Address - Fax:
Practice Address - Street 1:810 LIBERTY DR
Practice Address - Street 2:
Practice Address - City:SOMERDALE
Practice Address - State:NJ
Practice Address - Zip Code:08083-2007
Practice Address - Country:US
Practice Address - Phone:856-325-0944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-15
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ101YP2500XMedicaid
NJ1041C0700XMedicaid