Provider Demographics
NPI:1255591129
Name:PROKOP, PHILADELPHIA JEANE (LCSW/LCADC)
Entity type:Individual
Prefix:MS
First Name:PHILADELPHIA
Middle Name:JEANE
Last Name:PROKOP
Suffix:
Gender:F
Credentials:LCSW/LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 RAINBOW TER
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-5023
Mailing Address - Country:US
Mailing Address - Phone:973-325-0870
Mailing Address - Fax:
Practice Address - Street 1:516 VALLEY BROOK AVE
Practice Address - Street 2:
Practice Address - City:LYNDHURST
Practice Address - State:NJ
Practice Address - Zip Code:07071-1930
Practice Address - Country:US
Practice Address - Phone:201-935-3322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-13
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00121400101YA0400X
NJ44SC053638001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical