Provider Demographics
NPI:1821147554
Name:UNGER, GINA MARIE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:GINA
Middle Name:MARIE
Last Name:UNGER
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 1:48 PINE DR
Mailing Address - Street 2:
Mailing Address - City:CEDAR GROVE
Mailing Address - State:NJ
Mailing Address - Zip Code:07009-1036
Mailing Address - Country:US
Mailing Address - Phone:973-890-8637
Mailing Address - Fax:973-860-1326
Practice Address - Street 1:562 KINGSLAND ST
Practice Address - Street 2:
Practice Address - City:NUTLEY
Practice Address - State:NJ
Practice Address - Zip Code:07110-1069
Practice Address - Country:US
Practice Address - Phone:973-930-5507
Practice Address - Fax:973-860-1326
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC000413001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ053835YHEQOtherGROUP PTAN BURKE AND UNGER LIFEWORKS COUNSELING
NJ053835OtherPTAN