Provider Demographics
NPI:1003405440
Name:FRIEL, JASON R (MS, LAC)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:R
Last Name:FRIEL
Suffix:
Gender:M
Credentials:MS, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:268 MEYNER DR
Mailing Address - Street 2:
Mailing Address - City:BELLMAWR
Mailing Address - State:NJ
Mailing Address - Zip Code:08031-2058
Mailing Address - Country:US
Mailing Address - Phone:856-332-0592
Mailing Address - Fax:
Practice Address - Street 1:630 CLEMENTS BRIDGE RD
Practice Address - Street 2:
Practice Address - City:BARRINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08007-1814
Practice Address - Country:US
Practice Address - Phone:856-547-1107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-11
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00432200101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor