Provider Demographics
NPI:1891096988
Name:DYER, JENNIFER A (LMSW (NY), LCSW (NJ))
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:A
Last Name:DYER
Suffix:
Gender:F
Credentials:LMSW (NY), LCSW (NJ)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2050 FAIRFAX AVE
Mailing Address - Street 2:SUITE E
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08003-1607
Mailing Address - Country:US
Mailing Address - Phone:856-533-0550
Mailing Address - Fax:
Practice Address - Street 1:2050 FAIRFAX AVE
Practice Address - Street 2:SUITE E
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003-1607
Practice Address - Country:US
Practice Address - Phone:856-533-0550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-05
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC055989001041C0700X
NY081940-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker