Provider Demographics
NPI:1568481745
Name:DEVARIS, JEANNETTE M (PHD)
Entity Type:Individual
Prefix:DR
First Name:JEANNETTE
Middle Name:M
Last Name:DEVARIS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:189 SUMMIT AVE
Mailing Address - Street 2:
Mailing Address - City:SUMMIT
Mailing Address - State:NJ
Mailing Address - Zip Code:07901-2967
Mailing Address - Country:US
Mailing Address - Phone:908-522-0800
Mailing Address - Fax:908-517-9325
Practice Address - Street 1:189 SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:SUMMIT
Practice Address - State:NJ
Practice Address - Zip Code:07901-2967
Practice Address - Country:US
Practice Address - Phone:908-522-0800
Practice Address - Fax:908-517-9325
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35S100254300103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ117846OtherMEDICARE PTAN
NJ625672Medicare ID - Type Unspecified