Provider Demographics
NPI:1063005486
Name:SPUCKES, JENNIFER MICHELA (LPC, ACS)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:MICHELA
Last Name:SPUCKES
Suffix:
Gender:F
Credentials:LPC, ACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 ROSE LN
Mailing Address - Street 2:
Mailing Address - City:HACKETTSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07840-4720
Mailing Address - Country:US
Mailing Address - Phone:201-841-5806
Mailing Address - Fax:
Practice Address - Street 1:1 ROSE LN
Practice Address - Street 2:
Practice Address - City:HACKETTSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07840-4720
Practice Address - Country:US
Practice Address - Phone:201-841-5806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-17
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00440100101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional