Provider Demographics
NPI:1750657375
Name:PORTER, JENNIFER MARIE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:MARIE
Last Name:PORTER
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 1:6 JAMES ST
Mailing Address - Street 2:
Mailing Address - City:WHARTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07885-1023
Mailing Address - Country:US
Mailing Address - Phone:973-769-3037
Mailing Address - Fax:
Practice Address - Street 1:890 MOUNTAIN AVE
Practice Address - Street 2:
Practice Address - City:NEW PROVIDENCE
Practice Address - State:NJ
Practice Address - Zip Code:07974-1218
Practice Address - Country:US
Practice Address - Phone:908-277-8900
Practice Address - Fax:908-508-8919
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-28
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC054080001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical