Provider Demographics
NPI:1770123416
Name:BREA, JENNIFER L (LPC, NCC, MA, EDS)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:BREA
Suffix:
Gender:F
Credentials:LPC, NCC, MA, EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 25
Mailing Address - Street 2:
Mailing Address - City:LYNDHURST
Mailing Address - State:NJ
Mailing Address - Zip Code:07071-0025
Mailing Address - Country:US
Mailing Address - Phone:862-702-9554
Mailing Address - Fax:
Practice Address - Street 1:618 1ST STREET
Practice Address - Street 2:
Practice Address - City:LYNDHURST
Practice Address - State:NJ
Practice Address - Zip Code:07071
Practice Address - Country:US
Practice Address - Phone:862-702-9554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-10
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00862000101YP2500X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional