Provider Demographics
NPI:1083825889
Name:KING, JENNA (BS)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:KING
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 BETHANY RD
Mailing Address - Street 2:BUILDING 3, SUITE 42
Mailing Address - City:HAZLET
Mailing Address - State:NJ
Mailing Address - Zip Code:07730-1663
Mailing Address - Country:US
Mailing Address - Phone:732-264-4360
Mailing Address - Fax:732-264-8655
Practice Address - Street 1:1 BETHANY RD
Practice Address - Street 2:BUILDING 3, SUITE 42
Practice Address - City:HAZLET
Practice Address - State:NJ
Practice Address - Zip Code:07730-1663
Practice Address - Country:US
Practice Address - Phone:732-264-4360
Practice Address - Fax:732-264-8655
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor