Provider Demographics
NPI:1912347147
Name:DANIEL, JUSLEINE C (LCSW)
Entity Type:Individual
Prefix:
First Name:JUSLEINE
Middle Name:C
Last Name:DANIEL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 23
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08818-0023
Mailing Address - Country:US
Mailing Address - Phone:732-610-5119
Mailing Address - Fax:
Practice Address - Street 1:328 DENISON ST
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:08904-2732
Practice Address - Country:US
Practice Address - Phone:732-610-5119
Practice Address - Fax:908-275-8073
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-02
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00317100101YA0400X
NJ44SC055389001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0601021Medicaid