Provider Demographics
NPI:1245515337
Name:NEELY, JASON
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:NEELY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 AMBOY AVE STE B
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08837-3275
Mailing Address - Country:US
Mailing Address - Phone:732-301-4704
Mailing Address - Fax:
Practice Address - Street 1:800 AMBOY AVE STE B
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08837-3247
Practice Address - Country:US
Practice Address - Phone:732-301-4704
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-20
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMF1736106H00000X
NJ37FI00233000106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist