1720307275 NPI number — MS. JENNIFER J NEVERS MSW, LCSW

Table of content: MS. JENNIFER J NEVERS MSW, LCSW (NPI 1720307275)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720307275 NPI number — MS. JENNIFER J NEVERS MSW, LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NEVERS
Provider First Name:
JENNIFER
Provider Middle Name:
J
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MSW, LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FRYE
Provider Other First Name:
JENNIFER
Provider Other Middle Name:
J
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSW, LSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1720307275
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/21/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5411 STATE ROUTE 261
Provider Second Line Business Mailing Address:
#1161
Provider Business Mailing Address City Name:
NEWBURGH
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47629
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
812-575-4442
Provider Business Mailing Address Fax Number:
812-247-8156

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5411 STATE ROUTE 261
Provider Second Line Business Practice Location Address:
#1161
Provider Business Practice Location Address City Name:
NEWBURGH
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47629
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-575-4442
Provider Business Practice Location Address Fax Number:
812-247-8156
Provider Enumeration Date:
05/24/2010

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:  33005753A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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