Provider Demographics
NPI:1720232614
Name:JANE SMITH, MSW
Entity Type:Organization
Organization Name:JANE SMITH, MSW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PERSONAL ASSISTANT/SECRETARY
Authorized Official - Prefix:MS
Authorized Official - First Name:MAUREEN
Authorized Official - Middle Name:C
Authorized Official - Last Name:FITZPATRICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-701-0356
Mailing Address - Street 1:248 COLUMBIA TPKE
Mailing Address - Street 2:
Mailing Address - City:FLORHAM PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07932-1210
Mailing Address - Country:US
Mailing Address - Phone:973-377-1713
Mailing Address - Fax:
Practice Address - Street 1:248 COLUMBIA TPKE
Practice Address - Street 2:
Practice Address - City:FLORHAM PARK
Practice Address - State:NJ
Practice Address - Zip Code:07932-1210
Practice Address - Country:US
Practice Address - Phone:973-377-1713
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-05
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJSC04509700103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJSM806881Medicare PIN