Provider Demographics
NPI:1558146316
Name:JENSEN, BEVERLY ANNE
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:ANNE
Last Name:JENSEN
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 1:17 OAK ST APT 5
Mailing Address - Street 2:
Mailing Address - City:WEEHAWKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07086-5631
Mailing Address - Country:US
Mailing Address - Phone:646-593-9288
Mailing Address - Fax:
Practice Address - Street 1:1578 WILLIAMSBRIDGE RD APT 3E
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-6268
Practice Address - Country:US
Practice Address - Phone:855-771-0404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-30
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily