Provider Demographics
NPI:1013192160
Name:FLEMING, JASON S (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:S
Last Name:FLEMING
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 N DOUGHTY AVE
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08876-1811
Mailing Address - Country:US
Mailing Address - Phone:908-526-1177
Mailing Address - Fax:908-526-3139
Practice Address - Street 1:25 N DOUGHTY AVE
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08876-1811
Practice Address - Country:US
Practice Address - Phone:908-526-1177
Practice Address - Fax:908-526-3139
Is Sole Proprietor?:No
Enumeration Date:2008-01-08
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNJ PERMIT 043-492103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical