Provider Demographics
NPI:1336810340
Name:CHILDS, ZOE (LSW)
Entity Type:Individual
Prefix:
First Name:ZOE
Middle Name:
Last Name:CHILDS
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:616 S ORANGE AVE APT 8E
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07040-1041
Mailing Address - Country:US
Mailing Address - Phone:973-986-6640
Mailing Address - Fax:
Practice Address - Street 1:616 S ORANGE AVE APT 8E
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07040-1041
Practice Address - Country:US
Practice Address - Phone:973-986-6640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-21
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06651400104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker