Provider Demographics
NPI:1558657395
Name:CONTRERAS, JEANNINE (JEANNINE CONTRERAS)
Entity Type:Individual
Prefix:
First Name:JEANNINE
Middle Name:
Last Name:CONTRERAS
Suffix:
Gender:F
Credentials:JEANNINE CONTRERAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 PLYMOUTH AVE
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07040-2335
Mailing Address - Country:US
Mailing Address - Phone:973-761-9119
Mailing Address - Fax:
Practice Address - Street 1:50 PLYMOUTH AVE
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07040-2335
Practice Address - Country:US
Practice Address - Phone:973-761-9119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-20
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst