Provider Demographics
NPI:1073992301
Name:JENNIFER IACOVONE, LPC, LLC
Entity Type:Organization
Organization Name:JENNIFER IACOVONE, LPC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROFESSIONAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:IACOVONE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:856-214-2811
Mailing Address - Street 1:21 S JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:08096-5907
Mailing Address - Country:US
Mailing Address - Phone:856-214-2811
Mailing Address - Fax:
Practice Address - Street 1:68 PAULSBORO RD
Practice Address - Street 2:
Practice Address - City:WOOLWICH TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08085-1364
Practice Address - Country:US
Practice Address - Phone:856-214-2811
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-19
Last Update Date:2015-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00516500261QM0850X, 261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health