Provider Demographics
NPI:1235965278
Name:FINEGOLD, JASON ROBERT (LCSW)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:ROBERT
Last Name:FINEGOLD
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 1:125 WALKER AVE
Mailing Address - Street 2:
Mailing Address - City:ELKINS PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19027-1717
Mailing Address - Country:US
Mailing Address - Phone:917-288-8197
Mailing Address - Fax:
Practice Address - Street 1:125 WALKER AVE
Practice Address - Street 2:
Practice Address - City:ELKINS PARK
Practice Address - State:PA
Practice Address - Zip Code:19027-1717
Practice Address - Country:US
Practice Address - Phone:917-288-8197
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-09
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY072287-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty