Healthcare Provider Details

I. General information

NPI: 1548610744
Provider Name (Legal Business Name): JERNIECE SAEZ LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2016
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 SHOEMAKER LN
BRIDGETON NJ
08302-7005
US

IV. Provider business mailing address

102 W BROAD ST UNIT 1298
BRIDGETON NJ
08302-6629
US

V. Phone/Fax

Practice location:
  • Phone: 856-332-4514
  • Fax:
Mailing address:
  • Phone: 856-506-2207
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2425
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37PC00928000
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number100060
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: