Provider Demographics
NPI:1215128574
Name:LANKIN, JEANNE SHARON (MSW)
Entity type:Individual
Prefix:
First Name:JEANNE
Middle Name:SHARON
Last Name:LANKIN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 N 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08904-2937
Mailing Address - Country:US
Mailing Address - Phone:732-777-0292
Mailing Address - Fax:732-777-0292
Practice Address - Street 1:139 N 6TH AVE
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:08904-2937
Practice Address - Country:US
Practice Address - Phone:732-777-0292
Practice Address - Fax:732-777-0292
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-01
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC050128001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ043466Medicare UPIN