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
1	103G00000X	Clinical Neuropsychologist	35SI00390000	NJ
2	103TC0700X	Clinical Psychologist	35SI00390000	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID 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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