Provider Demographics
NPI:1073669115
Name:ZANE, JEREMY R (PSY, D)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:R
Last Name:ZANE
Suffix:
Gender:M
Credentials:PSY, D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MULLICA HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08062-9402
Mailing Address - Country:US
Mailing Address - Phone:609-202-3184
Mailing Address - Fax:
Practice Address - Street 1:39 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MULLICA HILL
Practice Address - State:NJ
Practice Address - Zip Code:08062-9402
Practice Address - Country:US
Practice Address - Phone:856-230-2919
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC005866101YA0400X, 101YM0800X, 101YP2500X
NJ35SI0058560103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000039278Medicaid