Provider Demographics
NPI:1508292459
Name:WRIGHT, JACQUELINE F
Entity Type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:F
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145A BAYVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07305-3368
Mailing Address - Country:US
Mailing Address - Phone:201-795-8046
Mailing Address - Fax:
Practice Address - Street 1:179 PALISADE AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-1103
Practice Address - Country:US
Practice Address - Phone:201-795-8375
Practice Address - Fax:201-795-8381
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-24
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SW00424200101Y00000X
NJ37LC00182700101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0295655Medicaid