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NPI Code Detail

MEDICARE: JACQUELINE ANN RONDEAU PSY.D.

MEDICARE: JACQUELINE ANN RONDEAU PSY.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103G00000XClinical Neuropsychologist35SI00390000NJ
2103TC0700XClinical Psychologist35SI00390000NJ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1285622217
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACQUELINE ANN RONDEAU PSY.D.
Provider Business Mailing Address
First Line : PO BOX 8121
Second Line :
City : GLEN RIDGE
State : NJ
Zip : 07028-8121
Country : US
Telephone Number : 973-743-4555
Fax Number : 973-743-4055
Provider Business Practice Location Address
First Line : 28 VALLEY RD
Second Line :
City : MONTCLAIR
State : NJ
Zip : 07042-2709
Country : US
Telephone Number : 973-746-4555
Fax Number : 973-783-4055
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/13/2005
Last Update Date : 04/19/2024

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