Provider Demographics
NPI:1033936265
Name:BAKELAS, THEMISTOKLIS (LCSW)
Entity type:Individual
Prefix:MR
First Name:THEMISTOKLIS
Middle Name:
Last Name:BAKELAS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 FIELD LN
Mailing Address - Street 2:
Mailing Address - City:DENVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07834-1311
Mailing Address - Country:US
Mailing Address - Phone:201-274-6150
Mailing Address - Fax:
Practice Address - Street 1:24 FIELD LN
Practice Address - Street 2:
Practice Address - City:DENVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07834-1311
Practice Address - Country:US
Practice Address - Phone:201-274-6150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-19
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC058949001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical