Provider Demographics
NPI:1740910298
Name:WELCH, JENNA KATHERINE (LSW)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:KATHERINE
Last Name:WELCH
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:KATHERINE
Other - Last Name:ULRICH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2 PINE BLVD
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08055-3401
Mailing Address - Country:US
Mailing Address - Phone:631-316-0418
Mailing Address - Fax:
Practice Address - Street 1:2 PINE BLVD
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:NJ
Practice Address - Zip Code:08055-3401
Practice Address - Country:US
Practice Address - Phone:631-316-0418
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-15
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06703700104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker