Provider Demographics
NPI:1588991988
Name:LICATA, JAYNE N (LCSW, LCADC)
Entity type:Individual
Prefix:MS
First Name:JAYNE
Middle Name:N
Last Name:LICATA
Suffix:
Gender:F
Credentials:LCSW, LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 BEAVERSON BLVD.
Mailing Address - Street 2:BLDG 1D
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08723
Mailing Address - Country:US
Mailing Address - Phone:732-920-7933
Mailing Address - Fax:732-920-2966
Practice Address - Street 1:35 BEAVERSON BLVD STE 1D
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08723
Practice Address - Country:US
Practice Address - Phone:732-920-7933
Practice Address - Fax:732-920-2966
Is Sole Proprietor?:No
Enumeration Date:2009-11-06
Last Update Date:2018-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)