Provider Demographics
NPI:1528611183
Name:PSOMAS-JACKLOSKI, JOSEPH PAUL (MSW, LCSW, LCADC)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:PAUL
Last Name:PSOMAS-JACKLOSKI
Suffix:
Gender:M
Credentials:MSW, LCSW, LCADC
Other - Prefix:
Other - First Name:JOSEPH
Other - Middle Name:PAUL
Other - Last Name:PSOMAS-JACKLOSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NONE
Mailing Address - Street 1:211 SHUNPIKE RD
Mailing Address - Street 2:
Mailing Address - City:CHATHAM
Mailing Address - State:NJ
Mailing Address - Zip Code:07928-1817
Mailing Address - Country:US
Mailing Address - Phone:973-635-8950
Mailing Address - Fax:
Practice Address - Street 1:99 BEAUVOIR AVE
Practice Address - Street 2:
Practice Address - City:SUMMIT
Practice Address - State:NJ
Practice Address - Zip Code:07901-3533
Practice Address - Country:US
Practice Address - Phone:973-255-6047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-22
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC051826001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical