Provider Demographics
NPI:1922286079
Name:JO L. VANDERKLOOT LCSW, P.C.
Entity Type:Organization
Organization Name:JO L. VANDERKLOOT LCSW, P.C.
Other - Org Name:JO L. VANDERKLOOT CSW, P.C.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:JO
Authorized Official - Middle Name:L
Authorized Official - Last Name:VANDERKLOOT
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:845-986-3560
Mailing Address - Street 1:83 ONDERDONK RD
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:NY
Mailing Address - Zip Code:10990-2909
Mailing Address - Country:US
Mailing Address - Phone:845-986-3560
Mailing Address - Fax:845-986-0255
Practice Address - Street 1:83 ONDERDONK RD
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:NY
Practice Address - Zip Code:10990-2909
Practice Address - Country:US
Practice Address - Phone:845-986-3560
Practice Address - Fax:845-986-0255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-31
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR-029237-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN 47512Medicare UPIN