=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760127005
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JENNIFER FUHR
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/02/2022
-----------------------------------------------------
Last Update Date | 05/02/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | THRIVE AT MONTVALE 110 SUMMIT AVENUE
-----------------------------------------------------
City | MONTVALE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07645
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-201-8815
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 109 HILLSIDE AVE
-----------------------------------------------------
City | MIDLAND PARK
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07432-1723
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-906-4755
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number | 44SC04530700
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------