Provider Demographics
NPI:1245904697
Name:USSERY, JODI LEAH
Entity type:Individual
Prefix:
First Name:JODI
Middle Name:LEAH
Last Name:USSERY
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 1:981 CEDAR GROVE RD
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-3414
Mailing Address - Country:US
Mailing Address - Phone:732-504-9738
Mailing Address - Fax:
Practice Address - Street 1:981 CEDAR GROVE RD
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-3414
Practice Address - Country:US
Practice Address - Phone:732-504-9738
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-08
Last Update Date:2021-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1-21-50208103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst