Provider Demographics
NPI:1851919229
Name:BOYER, JENNIFER KRISTINA (LCSW)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:KRISTINA
Last Name:BOYER
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 1:12 COLUMBIA AVE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07106-2102
Mailing Address - Country:US
Mailing Address - Phone:201-709-6497
Mailing Address - Fax:
Practice Address - Street 1:12 COLUMBIA AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07106-2102
Practice Address - Country:US
Practice Address - Phone:201-709-6497
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-11
Last Update Date:2020-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC057180001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical