Provider Demographics
NPI:1164937066
Name:PENOLA, JANE ALISON (LAC)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:ALISON
Last Name:PENOLA
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 FAYSON LAKE RD
Mailing Address - Street 2:
Mailing Address - City:KINNELON
Mailing Address - State:NJ
Mailing Address - Zip Code:07405-3124
Mailing Address - Country:US
Mailing Address - Phone:973-800-5663
Mailing Address - Fax:
Practice Address - Street 1:395 S CENTER ST
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07050-3205
Practice Address - Country:US
Practice Address - Phone:973-675-3817
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-13
Last Update Date:2017-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00369100101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor