Provider Demographics
NPI:1881988095
Name:PEREZ, JENNIFER (LPC)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:
Last Name:PEREZ
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:349 FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:NUTLEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07110-4004
Mailing Address - Country:US
Mailing Address - Phone:914-489-1133
Mailing Address - Fax:
Practice Address - Street 1:349 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:NUTLEY
Practice Address - State:NJ
Practice Address - Zip Code:07110-4004
Practice Address - Country:US
Practice Address - Phone:914-489-1133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-06
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00425900101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ37PC00425900OtherSTATE OF NEW JERSEY LICESE NUMBER