Provider Demographics
NPI:1295014736
Name:STIVERS, JENNIFER V (LCADC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:V
Last Name:STIVERS
Suffix:
Gender:F
Credentials:LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:U7 FARMHOUSE LN
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-3016
Mailing Address - Country:US
Mailing Address - Phone:973-952-0347
Mailing Address - Fax:
Practice Address - Street 1:14 MAIN ST
Practice Address - Street 2:SUITE 203
Practice Address - City:MADISON
Practice Address - State:NJ
Practice Address - Zip Code:07940-1818
Practice Address - Country:US
Practice Address - Phone:862-210-9841
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-15
Last Update Date:2011-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00173000101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)