MEDICARE: JACQUELINE A. RONDEAU PSY.D. CLINICAL PSYCHOLOGICAL &NEUROPSYCHOLOGIST

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	261Q00000X	Clinic/Center	35S100390000	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	:	1851316764
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JACQUELINE A. RONDEAU PSY.D. CLINICAL PSYCHOLOGICAL &NEUROPSYCHOLOGIST

Provider Business Mailing Address
First Line	:	375 BELLEVILLE AVE
Second Line	:	APT. 2
City	:	BLOOMFIELD
State	:	NJ
Zip	:	07003-2634
Country	:	US
Telephone Number	:	997-374-3455
Fax Number	:	973-743-4055

Provider Business Practice Location Address
First Line	:	70 PARK ST
Second Line	:	2ND FLOOR
City	:	MONTCLAIR
State	:	NJ
Zip	:	07042-5907
Country	:	US
Telephone Number	:	973-743-4555
Fax Number	:	973-743-4055

Authorized Official
Title or Position	:	SOLE PROPRIETOR
Name	:	JACQUELINE ANN RONDEAU
Credential	:	PSY.D.
Telephone Number	:	973-743-4555

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	08/22/2020

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