Provider Demographics
NPI:1114643004
Name:COZZARELLI, JENNIFER LAKE (LPC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LAKE
Last Name:COZZARELLI
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 BRIGHTON AVE
Mailing Address - Street 2:
Mailing Address - City:SPRING LAKE
Mailing Address - State:NJ
Mailing Address - Zip Code:07762-1515
Mailing Address - Country:US
Mailing Address - Phone:732-610-7562
Mailing Address - Fax:
Practice Address - Street 1:2130 ROUTE 35 STE 227
Practice Address - Street 2:
Practice Address - City:SEA GIRT
Practice Address - State:NJ
Practice Address - Zip Code:08750-1011
Practice Address - Country:US
Practice Address - Phone:732-610-7562
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-13
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00371500101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional