MEDICARE: DR. CHRISTOPHER TYRONE JENNINGS PHD

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
1	101Y00000X	Counselor
2	101Y00000X	Counselor	F23822	DE
3	101YM0800X	Mental Health Counselor
4	101YP2500X	Professional Counselor
5	103K00000X	Behavior Analyst
6	103TH0004X	Health Psychologist
7	103TP2701X	Group Psychotherapy Psychologist

General Provider Information

NPI Number	:	1740429539
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTOPHER TYRONE JENNINGS PHD

Provider Business Mailing Address
First Line	:	200 FEDERAL ST
Second Line	:	SUITE 227
City	:	CAMDEN
State	:	NJ
Zip	:	08103-1061
Country	:	US
Telephone Number	:	866-984-2665
Fax Number	:	866-634-2131

Provider Business Practice Location Address
First Line	:	200 FEDERAL ST
Second Line	:	SUITE 227
City	:	CAMDEN
State	:	NJ
Zip	:	08103-1061
Country	:	US
Telephone Number	:	866-984-2665
Fax Number	:	866-634-2131

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/18/2009
Last Update Date	:	02/18/2009

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