Provider Demographics
NPI:1922133156
Name:LESSNER, JEANNE (LCSW)
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:
Last Name:LESSNER
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 1:25 MACOPIN AVE
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07043-2024
Mailing Address - Country:US
Mailing Address - Phone:973-509-9130
Mailing Address - Fax:908-598-2408
Practice Address - Street 1:35 BEECHWOOD RD STE 3A B
Practice Address - Street 2:INTEGRATED BEHAVIORAL CARE PA
Practice Address - City:SUMMIT
Practice Address - State:NJ
Practice Address - Zip Code:07901-4604
Practice Address - Country:US
Practice Address - Phone:908-766-1000
Practice Address - Fax:908-598-2408
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC050924001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ056949Medicare ID - Type Unspecified