Provider Demographics
NPI:1558460949
Name:BAME, JENNIFER LEE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:LEE
Last Name:BAME
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 FRANKLIN TPKE STE 125
Mailing Address - Street 2:
Mailing Address - City:MAHWAH
Mailing Address - State:NJ
Mailing Address - Zip Code:07430-1325
Mailing Address - Country:US
Mailing Address - Phone:201-371-5113
Mailing Address - Fax:201-419-6082
Practice Address - Street 1:115 FRANKLIN TPKE STE 125
Practice Address - Street 2:
Practice Address - City:MAHWAH
Practice Address - State:NJ
Practice Address - Zip Code:07430-1325
Practice Address - Country:US
Practice Address - Phone:201-371-5113
Practice Address - Fax:201-419-6082
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ5374661041S0200X
NJ44SC052836001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool