Provider Demographics
NPI:1538701834
Name:WELSH, JENNA (LPC)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:WELSH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 ROUTE 34 STE 501
Mailing Address - Street 2:
Mailing Address - City:MATAWAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07747-3483
Mailing Address - Country:US
Mailing Address - Phone:732-765-2477
Mailing Address - Fax:
Practice Address - Street 1:1000 ROUTE 34 STE 501
Practice Address - Street 2:
Practice Address - City:MATAWAN
Practice Address - State:NJ
Practice Address - Zip Code:07747-3483
Practice Address - Country:US
Practice Address - Phone:732-765-2477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-08
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00728900101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health