Provider Demographics
NPI:1629739263
Name:LUPARDO, JENNA (LSW)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:LUPARDO
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:248 ROCK AVE
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07656-1426
Mailing Address - Country:US
Mailing Address - Phone:551-497-3930
Mailing Address - Fax:
Practice Address - Street 1:15 FARVIEW TER STE 1
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-2762
Practice Address - Country:US
Practice Address - Phone:551-579-4441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-05
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06656800104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker