Healthcare Provider Details

I. General information

NPI: 1609909589
Provider Name (Legal Business Name): JENNIFER JOHNSON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 HOWARD BLVD STE 101
MT ARLINGTON NJ
07856-1532
US

IV. Provider business mailing address

22 HOWARD BLVD. SUITE 101
MT. ARLINGTON NJ
07856
US

V. Phone/Fax

Practice location:
  • Phone: 973-770-7600
  • Fax: 973-770-7601
Mailing address:
  • Phone: 973-770-7600
  • Fax: 973-770-7601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37PC00355700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: