Provider Demographics
NPI:1366843997
Name:HUNTINGTON, JODI STEPHANIE (PHD)
Entity Type:Individual
Prefix:DR
First Name:JODI
Middle Name:STEPHANIE
Last Name:HUNTINGTON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 RAMAPO VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:MAHWAH
Mailing Address - State:NJ
Mailing Address - Zip Code:07430-2403
Mailing Address - Country:US
Mailing Address - Phone:973-476-6342
Mailing Address - Fax:201-961-6846
Practice Address - Street 1:711 RAMAPO VALLEY RD
Practice Address - Street 2:
Practice Address - City:MAHWAH
Practice Address - State:NJ
Practice Address - Zip Code:07430-2403
Practice Address - Country:US
Practice Address - Phone:973-476-6342
Practice Address - Fax:201-961-6846
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-15
Last Update Date:2014-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35S100534900103T00000X
NY020564103T00000X
NJ46TR00266100225X00000X
NY019091-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist