Provider Demographics
NPI:1053100420
Name:BEARD, JACK CHRISTOPHER (LSW)
Entity type:Individual
Prefix:
First Name:JACK
Middle Name:CHRISTOPHER
Last Name:BEARD
Suffix:
Gender:
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5303 STARK WAY UNIT 5303
Mailing Address - Street 2:
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-0120
Mailing Address - Country:US
Mailing Address - Phone:856-220-3965
Mailing Address - Fax:
Practice Address - Street 1:758 NJ-18 N
Practice Address - Street 2:#110
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816
Practice Address - Country:US
Practice Address - Phone:732-254-0600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-02
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL07204000104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker