Provider Demographics
NPI:1548049133
Name:DIMENNA, JACQUELINE (MA, LMFT, MHP)
Entity type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:
Last Name:DIMENNA
Suffix:
Gender:F
Credentials:MA, LMFT, MHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 CENTER ST UNIT 171
Mailing Address - Street 2:
Mailing Address - City:SEWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:08080-8008
Mailing Address - Country:US
Mailing Address - Phone:856-418-8857
Mailing Address - Fax:
Practice Address - Street 1:141 CENTER ST UNIT 171
Practice Address - Street 2:
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080-8008
Practice Address - Country:US
Practice Address - Phone:856-418-8857
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-25
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMF001410106H00000X
NJ37FI00213200106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist