Provider Demographics
NPI:1891303392
Name:JENNIFER RA LLC
Entity Type:Organization
Organization Name:JENNIFER RA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:RA
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:201-232-2806
Mailing Address - Street 1:307 BLOOMFIELD AVE STE 301
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07006-5105
Mailing Address - Country:US
Mailing Address - Phone:973-524-6501
Mailing Address - Fax:
Practice Address - Street 1:307 BLOOMFIELD AVE STE 301
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:NJ
Practice Address - Zip Code:07006-5105
Practice Address - Country:US
Practice Address - Phone:973-524-6501
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-21
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)