Provider Demographics
NPI:1841886306
Name:YARUSSI, JENNIFER (LPC, LCADC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:YARUSSI
Suffix:
Gender:F
Credentials:LPC, LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1140 BURNT TAVERN RD
Mailing Address - Street 2:SUITE 2C
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724-1496
Mailing Address - Country:US
Mailing Address - Phone:732-836-8112
Mailing Address - Fax:848-241-3641
Practice Address - Street 1:1140 BURNT TAVERN RD
Practice Address - Street 2:SUITE 2C
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724-1496
Practice Address - Country:US
Practice Address - Phone:732-836-8112
Practice Address - Fax:848-241-3641
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-17
Last Update Date:2020-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00204500101YA0400X
PAPC009985101YP2500X
NJ37PC00479100101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)