Provider Demographics
NPI:1255356093
Name:SMITH, JENNIFER J (PHD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:J
Last Name:SMITH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3535 STATE ROUTE 66
Mailing Address - Street 2:BLDG. #5, SUITE D
Mailing Address - City:NEPTUNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07753-2622
Mailing Address - Country:US
Mailing Address - Phone:732-643-4355
Mailing Address - Fax:732-643-4378
Practice Address - Street 1:3535 STATE ROUTE 66
Practice Address - Street 2:BLDG. #5, SUITE D
Practice Address - City:NEPTUNE
Practice Address - State:NJ
Practice Address - Zip Code:07753-2622
Practice Address - Country:US
Practice Address - Phone:732-643-4355
Practice Address - Fax:732-643-4378
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00370900103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist