Healthcare Provider Details

I. General information

NPI: 1992046726
Provider Name (Legal Business Name): JACQUELINE FARNESE, PSY.D., LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2013
Last Update Date: 06/26/2024
Certification Date: 06/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 SPRING ST
BORDENTOWN NJ
08505-1853
US

IV. Provider business mailing address

109 SPRING ST
BORDENTOWN NJ
08505-1853
US

V. Phone/Fax

Practice location:
  • Phone: 732-618-2969
  • Fax:
Mailing address:
  • Phone: 732-618-2969
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. JACQUELINE FARNESE
Title or Position: CLINICAL PSYCHOLOGIST
Credential: PSY.D.
Phone: 609-452-9794