Provider Demographics
NPI:1063472132
Name:ARENELLA, JESSICA (PHD)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:
Last Name:ARENELLA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 HORSENECK RD STE 1
Mailing Address - Street 2:
Mailing Address - City:MONTVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07045-9365
Mailing Address - Country:US
Mailing Address - Phone:917-304-5901
Mailing Address - Fax:973-299-6061
Practice Address - Street 1:353 W 48TH ST FL 3
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10036-1324
Practice Address - Country:US
Practice Address - Phone:917-304-5901
Practice Address - Fax:973-299-6061
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-24
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014931103TC0700X
NJ35SI00510100103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0537128Medicaid
NY02351962Medicaid
NJ0537128Medicaid
NYVL6141Medicare PIN
P52816Medicare UPIN