Provider Demographics
NPI:1255150504
Name:THOMAS, ASHA (LSW)
Entity type:Individual
Prefix:
First Name:ASHA
Middle Name:
Last Name:THOMAS
Suffix:
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1767 MORRIS AVE STE 303A
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-3511
Mailing Address - Country:US
Mailing Address - Phone:862-395-0943
Mailing Address - Fax:
Practice Address - Street 1:1767 MORRIS AVE STE 303A
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-3511
Practice Address - Country:US
Practice Address - Phone:862-395-0943
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-04
Last Update Date:2024-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL07167200104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker