Healthcare Provider Details

I. General information

NPI: 1699129866
Provider Name (Legal Business Name): JLF COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2016
Last Update Date: 04/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

324 BELLEVILLE AVE
BLOOMFIELD NJ
07003-3554
US

IV. Provider business mailing address

324 BELLEVILLE AVE
BLOOMFIELD NJ
07003-3554
US

V. Phone/Fax

Practice location:
  • Phone: 201-463-3921
  • Fax:
Mailing address:
  • Phone: 201-463-3921
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: JERRY L FULLER JR.
Title or Position: OWNER
Credential: LCSW LCADC
Phone: 201-463-3921