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NPI Code Detail

MEDICARE: TERRY LESLIE JENSEN LCSW

MEDICARE: TERRY LESLIE JENSEN LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker44SC00847000NJ

General Provider Information

NPI Number : 1659466795
Entity Type Code : Individual
Provider Name (Legal Business Name) : TERRY LESLIE JENSEN LCSW
Provider Business Mailing Address
First Line : 18 EUGENE DR
Second Line :
City : MONTVILLE
State : NJ
Zip : 07045-9015
Country : US
Telephone Number : 732-493-8080
Fax Number : 732-493-8810
Provider Business Practice Location Address
First Line : 931 W PARK AVE
Second Line :
City : OCEAN
State : NJ
Zip : 07712-7207
Country : US
Telephone Number : 732-493-8080
Fax Number : 732-490-8810
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/04/2006
Last Update Date : 07/08/2007

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Directions to “ TERRY LESLIE JENSEN LCSW” Practice Location

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