1942688106 NPI number — MRS. JENNIFER A UNGER LCSW, LCADC

Table of content: MRS. JENNIFER A UNGER LCSW, LCADC (NPI 1942688106)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942688106 NPI number — MRS. JENNIFER A UNGER LCSW, LCADC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
UNGER
Provider First Name:
JENNIFER
Provider Middle Name:
A
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW, LCADC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KILDEA
Provider Other First Name:
JENNIFER
Provider Other Middle Name:
A.
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSW, LSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1942688106
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/19/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5 REGENT STREET, SUITE 518
Provider Second Line Business Mailing Address:
GENPSYCH
Provider Business Mailing Address City Name:
LIVINGSTON
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07039
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-994-1011
Provider Business Mailing Address Fax Number:
973-994-1220

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
395 SOUTH CENTER STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ORANGE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07050
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-675-3817
Provider Business Practice Location Address Fax Number:
973-673-5782
Provider Enumeration Date:
05/08/2015

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  44SC05659200 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YA0400X , with the licence number: 37LC00239700 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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