Healthcare Provider Details

I. General information

NPI: 1629933825
Provider Name (Legal Business Name): JENNAH MAJEED-BEMBRY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

183 S ORANGE AVE
NEWARK NJ
07103-2757
US

IV. Provider business mailing address

671 HOES LN W
PISCATAWAY NJ
08854-8021
US

V. Phone/Fax

Practice location:
  • Phone: 973-972-6100
  • Fax: 973-972-0218
Mailing address:
  • Phone: 973-972-6100
  • Fax: 973-972-0218

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number37AC00308900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: