Provider Demographics
NPI:1104421320
Name:KAFKA, JACOB
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:
Last Name:KAFKA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 W ENGLEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-5015
Mailing Address - Country:US
Mailing Address - Phone:201-978-9468
Mailing Address - Fax:
Practice Address - Street 1:125 W ENGLEWOOD AVE
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-5015
Practice Address - Country:US
Practice Address - Phone:201-978-9468
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-04
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC059610001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical