Provider Demographics
NPI:1831888494
Name:LARA, JOCELYN (LSW)
Entity type:Individual
Prefix:
First Name:JOCELYN
Middle Name:
Last Name:LARA
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 1:661 STUYVESANT AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:IRVINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07111-4056
Mailing Address - Country:US
Mailing Address - Phone:862-223-0896
Mailing Address - Fax:
Practice Address - Street 1:320 SUYDAM ST
Practice Address - Street 2:
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-2417
Practice Address - Country:US
Practice Address - Phone:732-246-4025
Practice Address - Fax:732-246-1214
Is Sole Proprietor?:No
Enumeration Date:2023-05-01
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC064684001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical