Provider Demographics
NPI:1386227528
Name:FIDUCCIA, JENNIFER L (LSW)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:FIDUCCIA
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98 OAK TREE LN
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-2522
Mailing Address - Country:US
Mailing Address - Phone:609-618-3997
Mailing Address - Fax:
Practice Address - Street 1:687 ATLANTIC CITY BLVD
Practice Address - Street 2:
Practice Address - City:BAYVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08721-2548
Practice Address - Country:US
Practice Address - Phone:733-349-5550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-05
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06634800104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker