MEDICARE: JEFFRIE POPPLEWELL LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101YM0800X	Mental Health Counselor
2	101YP2500X	Professional Counselor
3	101YP1600X	Pastoral Counselor
4	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1871068916
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JEFFRIE POPPLEWELL LLC

Provider Business Mailing Address
First Line	:	300 GORGE RD APT 72
Second Line	:
City	:	CLIFFSIDE PARK
State	:	NJ
Zip	:	07010-2770
Country	:	US
Telephone Number	:	201-957-3497
Fax Number	:	201-886-9531

Provider Business Practice Location Address
First Line	:	245 STANTON MT RD
Second Line	:
City	:	LEBANON
State	:	NJ
Zip	:	08833-3106
Country	:	US
Telephone Number	:	201-957-3497
Fax Number	:	201-886-9531

Authorized Official
Title or Position	:	BUSINESS OWNER
Name	:	JEFFRIE POPPLEWELL
Credential	:	MA, LPC, LCADC
Telephone Number	:	201-957-3497

Provider Enumeration Date	:	10/04/2018
Last Update Date	:	04/09/2019

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Directions to “JEFFRIE POPPLEWELL LLC ” Practice Location

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