Basic Information
| Provider Information | |||||||||
| NPI: | 1992869275 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | INFRANCO | ||||||||
| FirstName: | JEANMARIE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PHD, LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 671 HOES LN W | ||||||||
| Address2: | |||||||||
| City: | PISCATAWAY | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 088548021 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7322355900 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 10 CORPORATE PL S | ||||||||
| Address2: | SUITE 205 | ||||||||
| City: | PISCATAWAY | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 088546148 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7322355000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/20/2006 | ||||||||
| LastUpdateDate: | 03/30/2016 | ||||||||
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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 | 101YP2500X | 0701004098 | VA | N | Behavioral Health & Social Service Providers | Counselor | Professional | 101YP2500X | 37PC00473600 | NJ | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
ID Information
| ID | Type | State | Issuer | Description | 004945247 | 05 | VA | MEDICAID |