Provider Demographics
NPI:1558938522
Name:GENERATION OF CHANGE LLC
Entity Type:Organization
Organization Name:GENERATION OF CHANGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER/PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:JEBITSCH
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:610-222-6436
Mailing Address - Street 1:1620 POND RD STE 75
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-2280
Mailing Address - Country:US
Mailing Address - Phone:610-222-6436
Mailing Address - Fax:
Practice Address - Street 1:1620 POND RD STE 75
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-2280
Practice Address - Country:US
Practice Address - Phone:610-417-8198
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-08
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty