Provider Demographics
NPI:1659466795
Name:JENSEN, TERRY LESLIE (LCSW)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:LESLIE
Last Name:JENSEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 EUGENE DR
Mailing Address - Street 2:
Mailing Address - City:MONTVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07045-9015
Mailing Address - Country:US
Mailing Address - Phone:732-493-8080
Mailing Address - Fax:732-493-8810
Practice Address - Street 1:931 W PARK AVE
Practice Address - Street 2:
Practice Address - City:OCEAN
Practice Address - State:NJ
Practice Address - Zip Code:07712-7207
Practice Address - Country:US
Practice Address - Phone:732-493-8080
Practice Address - Fax:732-490-8810
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC008470001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ901503RJKMedicare ID - Type Unspecified