Provider Demographics
NPI:1679717961
Name:MARCELLA, JENNIFER (LSW)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:MARCELLA
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 1:385 BROOKVIEW CT
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07731-3031
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:725 AIRPORT ROAD
Practice Address - Street 2:PREFERRED BEHAVIORAL HEALTH OF NJ
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701
Practice Address - Country:US
Practice Address - Phone:732-367-8859
Practice Address - Fax:732-367-8242
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-30
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL055352001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0029807Medicaid