Healthcare Provider Details

I. General information

NPI: 1780271866
Provider Name (Legal Business Name): JENNA TIBERI LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/23/2020
Last Update Date: 09/26/2024
Certification Date: 09/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 PRINCESS RD STE 206
LAWRENCEVILLE NJ
08648-2322
US

IV. Provider business mailing address

4 PRINCESS RD STE 206
LAWRENCEVILLE NJ
08648-2322
US

V. Phone/Fax

Practice location:
  • Phone: 609-468-3231
  • Fax:
Mailing address:
  • Phone: 609-468-3231
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC6189400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: