Provider Demographics
NPI:1598484560
Name:ROMA, JENNA (LSW)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:ROMA
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:
Other - Last Name:HOLDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW
Mailing Address - Street 1:150 W HIGH ST STE A
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08876-1854
Mailing Address - Country:US
Mailing Address - Phone:908-725-7799
Mailing Address - Fax:908-725-0284
Practice Address - Street 1:150 W HIGH ST STE A
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08876-1854
Practice Address - Country:US
Practice Address - Phone:908-725-7799
Practice Address - Fax:908-725-0284
Is Sole Proprietor?:No
Enumeration Date:2022-08-24
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJSWGTL22028461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJSWGTL2202846Medicaid