Provider Demographics
NPI:1881891836
Name:HANNA, JENNIS E (PHD)
Entity type:Individual
Prefix:
First Name:JENNIS
Middle Name:E
Last Name:HANNA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 GATES AVE
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-3213
Mailing Address - Country:US
Mailing Address - Phone:973-655-0432
Mailing Address - Fax:
Practice Address - Street 1:60 EVERGREEN PL FL 10
Practice Address - Street 2:
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07018-2107
Practice Address - Country:US
Practice Address - Phone:973-395-5500
Practice Address - Fax:973-395-9916
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00338600103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical