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General NPI Number Information
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NPI Number | 1861105603
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Entity Type | Organization
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Legal Business Name | JENNIFER A. CARLSON, PSY D
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Dates
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Enumeration Date | 12/26/2022
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Last Update Date | 12/26/2022
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Provider Practice Location Address
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Address Line | 10 MCKINLEY ST STE 12
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City | CLOSTER
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State | NJ
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Zip | 07624-2726
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Country | US
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Telephone | 201-960-6614
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Fax | 201-890-8027
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Provider Business Mailing Address
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Address Line | 10 MCKINLEY ST STE 12
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City | CLOSTER
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State | NJ
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Zip | 07624-2726
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Country | US
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Telephone | 201-960-6614
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Fax | 201-890-8027
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Authorized Official
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Title or Position | OWNER
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Name | DR. JENNIFER A CARLSON
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Credential | PSY D
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Telephone | 201-960-6614
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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