Provider Demographics
NPI:1780979997
Name:JARVIS, MEGAN MARIONETTA (LPN)
Entity type:Individual
Prefix:MS
First Name:MEGAN
Middle Name:MARIONETTA
Last Name:JARVIS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 LUKE ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH AMBOY
Mailing Address - State:NJ
Mailing Address - Zip Code:08879-2235
Mailing Address - Country:US
Mailing Address - Phone:732-525-5379
Mailing Address - Fax:
Practice Address - Street 1:70 LUKE ST
Practice Address - Street 2:
Practice Address - City:SOUTH AMBOY
Practice Address - State:NJ
Practice Address - Zip Code:08879-2235
Practice Address - Country:US
Practice Address - Phone:732-525-5379
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-15
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY176263-1101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)