Provider Demographics
NPI:1922600626
Name:HENDRICKSEN, JENNA L
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:L
Last Name:HENDRICKSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 MEADOW AVE
Mailing Address - Street 2:
Mailing Address - City:MONMOUTH BEACH
Mailing Address - State:NJ
Mailing Address - Zip Code:07750-1024
Mailing Address - Country:US
Mailing Address - Phone:908-433-8373
Mailing Address - Fax:
Practice Address - Street 1:6 E 39TH ST STE 503
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-0448
Practice Address - Country:US
Practice Address - Phone:917-510-6422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-09
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist