Individual
MS. PHILADELPHIA JEANE PROKOP
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW/LCADC
Contact information
Practice address
516 VALLEY BROOK AVE, LYNDHURST, NJ 07071-1930
(201) 935-3322
Mailing address
14 RAINBOW TER, WEST ORANGE, NJ 07052-5023
(973) 325-0870
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
37LC00121400
NJ
1041C0700X
Clinical Social Worker
44SC05363800
NJ
Other
Enumeration date
06/13/2008
Last updated
06/13/2008
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