Provider Demographics
NPI:1578216248
Name:AHEARN, JESSICA ALEXANDRIA (MA, LAC, NCC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ALEXANDRIA
Last Name:AHEARN
Suffix:
Gender:F
Credentials:MA, LAC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 EMMA PL
Mailing Address - Street 2:
Mailing Address - City:EATONTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07724-1912
Mailing Address - Country:US
Mailing Address - Phone:732-832-5873
Mailing Address - Fax:
Practice Address - Street 1:1806 ROUTE 35 STE 205C
Practice Address - Street 2:
Practice Address - City:OAKHURST
Practice Address - State:NJ
Practice Address - Zip Code:07755-2759
Practice Address - Country:US
Practice Address - Phone:848-863-9728
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-01
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00622700101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty