Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 44SC05613500 | NJ |
NPI | 1003204132 |
---|---|
Provider Name | Mrs. Jennifer Anne Surak-Zammitti |
First Address | Closter, NJ 07624-1912 |
Second Address | Closter, NJ 07624 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/12/2014 |
Last Update Date | 31/07/2018 |