Provider Demographics
NPI:1760289128
Name:KPOLIE, JEFF AMBROSE (LSW)
Entity type:Individual
Prefix:
First Name:JEFF
Middle Name:AMBROSE
Last Name:KPOLIE
Suffix:
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 AMAN AVE
Mailing Address - Street 2:
Mailing Address - City:LINDENWOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:08021-2545
Mailing Address - Country:US
Mailing Address - Phone:856-236-3415
Mailing Address - Fax:
Practice Address - Street 1:223 GIBBSBORO RD
Practice Address - Street 2:
Practice Address - City:CLEMENTON
Practice Address - State:NJ
Practice Address - Zip Code:08021-4135
Practice Address - Country:US
Practice Address - Phone:856-236-3415
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-25
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL05957300104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker