Provider Demographics
NPI:1760146757
Name:GONZALES, JENNY MARIE (LSW)
Entity Type:Individual
Prefix:MS
First Name:JENNY
Middle Name:MARIE
Last Name:GONZALES
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 1:22 CLEVELAND AVE
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:NJ
Mailing Address - Zip Code:07029-1316
Mailing Address - Country:US
Mailing Address - Phone:201-341-6253
Mailing Address - Fax:
Practice Address - Street 1:201 MONTGOMERY ST STE 2
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07302-5052
Practice Address - Country:US
Practice Address - Phone:862-212-0913
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-26
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ12129771041S0200X
NJ44SL06720100104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool