Provider Demographics
NPI:1346703667
Name:PEREIRA, JADE ASHLEY
Entity Type:Individual
Prefix:
First Name:JADE
Middle Name:ASHLEY
Last Name:PEREIRA
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 1:316 DANIELE DR
Mailing Address - Street 2:
Mailing Address - City:OCEAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07712-7907
Mailing Address - Country:US
Mailing Address - Phone:732-642-9652
Mailing Address - Fax:
Practice Address - Street 1:316 DANIELE DR
Practice Address - Street 2:
Practice Address - City:OCEAN
Practice Address - State:NJ
Practice Address - Zip Code:07712-7907
Practice Address - Country:US
Practice Address - Phone:732-642-9652
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-12
Last Update Date:2019-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst