Provider Demographics
NPI:1497519722
Name:AVENA PSYCHOLOGICAL SERVICES LLC
Entity Type:Organization
Organization Name:AVENA PSYCHOLOGICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:AVENA
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:347-378-4588
Mailing Address - Street 1:344 GROVE ST # 4001
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302-5923
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:344 GROVE ST # 4001
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07302-5923
Practice Address - Country:US
Practice Address - Phone:212-906-4495
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AVENA PSYCHOLOGICAL SERVICES PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-02-07
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty