Provider Demographics
NPI:1376011197
Name:JEA COUNSELING LLC
Entity Type:Organization
Organization Name:JEA COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JODI
Authorized Official - Middle Name:E
Authorized Official - Last Name:AMORESE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:908-892-7376
Mailing Address - Street 1:202 E FAIRFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18040-1324
Mailing Address - Country:US
Mailing Address - Phone:908-892-7376
Mailing Address - Fax:908-235-4374
Practice Address - Street 1:202 E FAIRFIELD AVE
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18040-1324
Practice Address - Country:US
Practice Address - Phone:908-892-7376
Practice Address - Fax:908-235-4374
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-09
Last Update Date:2018-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1346636032Medicaid