Healthcare Provider Details

I. General information

NPI: 1912861709
Provider Name (Legal Business Name): JACQUELINE REYNOLDS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 TENNENT RD STE 104
MANALAPAN NJ
07726-3163
US

IV. Provider business mailing address

660 TENNENT RD STE 104
MANALAPAN NJ
07726-3163
US

V. Phone/Fax

Practice location:
  • Phone: 732-851-4808
  • Fax:
Mailing address:
  • Phone: 732-851-4808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37PC00547500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: