Provider Demographics
NPI:1336162189
Name:KONRAD, JACALYN MICHELE (MSW, LCSW)
Entity type:Individual
Prefix:MS
First Name:JACALYN
Middle Name:MICHELE
Last Name:KONRAD
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 MAHAR AVE
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07011
Mailing Address - Country:US
Mailing Address - Phone:973-478-2468
Mailing Address - Fax:
Practice Address - Street 1:106 OLD HOOK ROAD
Practice Address - Street 2:
Practice Address - City:WESTOOD
Practice Address - State:NJ
Practice Address - Zip Code:07675
Practice Address - Country:US
Practice Address - Phone:201-666-2400
Practice Address - Fax:201-666-2334
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC051709001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical