Provider Demographics
NPI:1457930323
Name:ARDON, JACQUELINE (LSW)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:ARDON
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 EXECUTIVE DR
Mailing Address - Street 2:
Mailing Address - City:MORRIS PLAINS
Mailing Address - State:NJ
Mailing Address - Zip Code:07950-2155
Mailing Address - Country:US
Mailing Address - Phone:862-432-6371
Mailing Address - Fax:973-285-0067
Practice Address - Street 1:3 EXECUTIVE DR
Practice Address - Street 2:
Practice Address - City:MORRIS PLAINS
Practice Address - State:NJ
Practice Address - Zip Code:07950-2155
Practice Address - Country:US
Practice Address - Phone:973-285-0006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-06
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06440200104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker