Healthcare Provider Details

I. General information

NPI: 1285156653
Provider Name (Legal Business Name): MS. JENNIFER LYNN ALVICH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

74 COLUMBIA TERRACE
WEEHAWKEN NJ
07086
US

IV. Provider business mailing address

74 COLUMBIA TER
WEEHAWKEN NJ
07086-7062
US

V. Phone/Fax

Practice location:
  • Phone: 201-446-3531
  • Fax:
Mailing address:
  • Phone: 201-446-3531
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0000000000
Identifier TypeOTHER
Identifier State
Identifier IssuerINDIVIDUAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: