Provider Demographics
NPI:1760880413
Name:MCCLENDON, JENNIFER (LPC, LCPC, LCADC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:MCCLENDON
Suffix:
Gender:F
Credentials:LPC, LCPC, LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 753
Mailing Address - Street 2:
Mailing Address - City:PISCATAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08855-0753
Mailing Address - Country:US
Mailing Address - Phone:732-588-8740
Mailing Address - Fax:855-240-7470
Practice Address - Street 1:371 HOES LN STE 200
Practice Address - Street 2:
Practice Address - City:PISCATAWAY
Practice Address - State:NJ
Practice Address - Zip Code:08854-4143
Practice Address - Country:US
Practice Address - Phone:732-588-8740
Practice Address - Fax:855-240-7470
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-11
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00190400101YA0400X
NJ37PC00505800101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0560715Medicaid