Provider Demographics
NPI:1225332349
Name:PARK, JENNIFER H
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:H
Last Name:PARK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:233 FAIR VALLEY RD # 1
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16662-7868
Mailing Address - Country:US
Mailing Address - Phone:814-793-3486
Mailing Address - Fax:
Practice Address - Street 1:3759 BUSINESS ROUTE 220
Practice Address - Street 2:SUITE 1
Practice Address - City:BEDFORD
Practice Address - State:PA
Practice Address - Zip Code:15522
Practice Address - Country:US
Practice Address - Phone:814-623-1212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-04
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health