Provider Demographics
NPI:1730221276
Name:PEARL, SYLVIA D
Entity type:Individual
Prefix:
First Name:SYLVIA
Middle Name:D
Last Name:PEARL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:658 RIDGEWOOD RD
Mailing Address - Street 2:8
Mailing Address - City:MAPLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07040-2536
Mailing Address - Country:US
Mailing Address - Phone:973-762-6865
Mailing Address - Fax:973-762-6776
Practice Address - Street 1:658 RIDGEWOOD RD
Practice Address - Street 2:8
Practice Address - City:MAPLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07040-2536
Practice Address - Country:US
Practice Address - Phone:973-762-6865
Practice Address - Fax:973-762-6776
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJSC 060111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ640793Medicare UPIN