Provider Demographics
NPI:1851316764
Name:JACQUELINE A. RONDEAU PSY.D. CLINICAL PSYCHOLOGICAL &NEUROPSYCHOLOGIST
Entity Type:Organization
Organization Name:JACQUELINE A. RONDEAU PSY.D. CLINICAL PSYCHOLOGICAL &NEUROPSYCHOLOGIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:RONDEAU
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:973-743-4555
Mailing Address - Street 1:375 BELLEVILLE AVE
Mailing Address - Street 2:APT. 2
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-2634
Mailing Address - Country:US
Mailing Address - Phone:997-374-3455
Mailing Address - Fax:973-743-4055
Practice Address - Street 1:70 PARK ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-5907
Practice Address - Country:US
Practice Address - Phone:973-743-4555
Practice Address - Fax:973-743-4055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35S100390000261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0051349Medicaid
NJ049043Medicare ID - Type Unspecified
NJ0051349Medicaid