Provider Demographics
NPI:1447753074
Name:TUNNICLIFFE, JAY ANDREW
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:ANDREW
Last Name:TUNNICLIFFE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 OHIO AVE
Mailing Address - Street 2:
Mailing Address - City:EGG HARBOR TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08234-7223
Mailing Address - Country:US
Mailing Address - Phone:609-317-3650
Mailing Address - Fax:
Practice Address - Street 1:207 OHIO AVE
Practice Address - Street 2:
Practice Address - City:EGG HARBOR TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08234-7223
Practice Address - Country:US
Practice Address - Phone:609-317-3650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-09
Last Update Date:2018-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06340600104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker