Provider Demographics
NPI:1942535224
Name:PARKER, JENNIFER
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:PARKER
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 1:835 SPRINGDALE DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341-2841
Mailing Address - Country:US
Mailing Address - Phone:610-363-1488
Mailing Address - Fax:
Practice Address - Street 1:254 E MAIN ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19711-7311
Practice Address - Country:US
Practice Address - Phone:302-731-1504
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-05
Last Update Date:2009-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE905101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)