Basic Information
| Provider Information | |||||||||
| NPI: | 1255356093 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SMITH | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3535 STATE ROUTE 66 | ||||||||
| Address2: | BLDG. #5, SUITE D | ||||||||
| City: | NEPTUNE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 077532622 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7326434355 | ||||||||
| FaxNumber: | 7326434378 | ||||||||
| Practice Location | |||||||||
| Address1: | 3535 STATE ROUTE 66 | ||||||||
| Address2: | BLDG. #5, SUITE D | ||||||||
| City: | NEPTUNE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 077532622 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7326434355 | ||||||||
| FaxNumber: | 7326434378 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | 35SI00370900 | NJ | Y | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.