Healthcare Provider Details

I. General information

NPI: 1235634742
Provider Name (Legal Business Name): JENNIFER OHARA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2018
Last Update Date: 03/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1311 BRANDYWINE BLVD
WILMINGTON DE
19809-2306
US

IV. Provider business mailing address

1311 BRANDYWINE BLVD
WILMINGTON DE
19809-2306
US

V. Phone/Fax

Practice location:
  • Phone: 302-793-5072
  • Fax:
Mailing address:
  • Phone: 302-793-5072
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number90352
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: