Provider Demographics
NPI:1568132587
Name:JERNIGAN, JANA'E ALESE (MS)
Entity Type:Individual
Prefix:
First Name:JANA'E
Middle Name:ALESE
Last Name:JERNIGAN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1030 GROVE AVE APT 33G
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-1543
Mailing Address - Country:US
Mailing Address - Phone:732-810-9710
Mailing Address - Fax:
Practice Address - Street 1:1030 GROVE AVE APT 33G
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-1543
Practice Address - Country:US
Practice Address - Phone:732-810-9710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-20
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1363660103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty