Healthcare Provider Details

I. General information

NPI: 1730637448
Provider Name (Legal Business Name): JACQUELINE OBREGON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2016
Last Update Date: 09/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 N BRIDGE ST
BRIDGEWATER NJ
08807-2135
US

IV. Provider business mailing address

500 N BRIDGE ST
BRIDGEWATER NJ
08807-2135
US

V. Phone/Fax

Practice location:
  • Phone: 908-725-2800
  • Fax: 908-704-1790
Mailing address:
  • Phone: 908-725-2800
  • Fax: 908-704-1790

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: