Provider Demographics
NPI:1124181607
Name:WADDELL, JAYNE LYNCH (RN LPC)
Entity Type:Individual
Prefix:MRS
First Name:JAYNE
Middle Name:LYNCH
Last Name:WADDELL
Suffix:
Gender:F
Credentials:RN LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 COLONIAL ROAD
Mailing Address - Street 2:
Mailing Address - City:TENAFLY
Mailing Address - State:NJ
Mailing Address - Zip Code:07670
Mailing Address - Country:US
Mailing Address - Phone:201-568-7902
Mailing Address - Fax:201-568-7902
Practice Address - Street 1:140 COUNTY ROAD STE 106
Practice Address - Street 2:
Practice Address - City:TENAFLY
Practice Address - State:NJ
Practice Address - Zip Code:07670
Practice Address - Country:US
Practice Address - Phone:201-248-3950
Practice Address - Fax:201-248-3950
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00013300-LPC101Y00000X
NJ26N004232900163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered163W00000XNursing Service ProvidersRegistered Nurse