Basic Information
| Provider Information | |||||||||
| NPI: | 1710303946 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | IVINS | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | A. | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LPC | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | IVINS-ELDER | ||||||||
| OtherFirstName: | JENNIFER | ||||||||
| OtherMiddleName: | A. | ||||||||
| OtherNamePrefix: | MS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | LPC | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 215 HIGHLAND AVE | ||||||||
| Address2: | SUITE C | ||||||||
| City: | HADDON TOWNSHIP | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 081082634 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8568543155 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 215 HIGHLAND AVE | ||||||||
| Address2: | SUITE C | ||||||||
| City: | WESTMONET | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 08108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8568543155 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/12/2014 | ||||||||
| LastUpdateDate: | 03/12/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 37LPC00046400 | NJ | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.