Provider Demographics
NPI:1750516027
Name:JERRI SHANKLER MSW LCSW LCADC
Entity type:Organization
Organization Name:JERRI SHANKLER MSW LCSW LCADC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JERRI
Authorized Official - Middle Name:
Authorized Official - Last Name:SHANKLER
Authorized Official - Suffix:
Authorized Official - Credentials:MSW LCSW LCADC
Authorized Official - Phone:201-452-1432
Mailing Address - Street 1:25 VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07418-1657
Mailing Address - Country:US
Mailing Address - Phone:201-452-1432
Mailing Address - Fax:
Practice Address - Street 1:25 VALLEY DR
Practice Address - Street 2:
Practice Address - City:GLENWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07418-1657
Practice Address - Country:US
Practice Address - Phone:201-452-1432
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-15
Last Update Date:2009-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC043916001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty