Provider Demographics
NPI:1821285008
Name:BESSEY, JEFFREY LAWRENCE (PHD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:LAWRENCE
Last Name:BESSEY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 BRIAR HILL LN
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:08096-5860
Mailing Address - Country:US
Mailing Address - Phone:856-848-5937
Mailing Address - Fax:856-848-5938
Practice Address - Street 1:310 BRIAR HILL LN
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NJ
Practice Address - Zip Code:08096-5860
Practice Address - Country:US
Practice Address - Phone:856-848-5937
Practice Address - Fax:856-848-5938
Is Sole Proprietor?:No
Enumeration Date:2007-10-01
Last Update Date:2007-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2573103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3385507Medicaid
5963134OtherAETNA
NJ573399DSMMedicare PIN
BE573399Medicare UPIN
NJ573399Medicare PIN