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General NPI Number Information
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NPI Number | 1972292456
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Entity Type | Organization
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Legal Business Name | PENNY HAVEN LLC
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Dates
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Enumeration Date | 05/02/2023
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Last Update Date | 05/02/2023
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Provider Practice Location Address
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Address Line | 56 ROUTE 173 STE 1H
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City | HAMPTON
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State | NJ
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Zip | 08827-4021
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Country | US
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Telephone | 908-399-1558
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Fax |
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Provider Business Mailing Address
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Address Line | 102 LITTLE YORK PATTENBURG RD
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City | MILFORD
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State | NJ
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Zip | 08848-2059
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Country | US
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Telephone | 908-399-1558
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JENNIFER JONES
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Credential | LCADC, LCSW
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Telephone | 908-399-1558
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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