Provider Demographics
NPI:1730246448
Name:MARCO, JENNIFER (LCSW)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:MARCO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 NEW RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:NORTHFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08225-1457
Mailing Address - Country:US
Mailing Address - Phone:609-677-9500
Mailing Address - Fax:609-677-9291
Practice Address - Street 1:2300 NEW RD
Practice Address - Street 2:SUITE 101
Practice Address - City:NORTHFIELD
Practice Address - State:NJ
Practice Address - Zip Code:08225-1457
Practice Address - Country:US
Practice Address - Phone:609-677-9500
Practice Address - Fax:609-677-9291
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC043356001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7676003OtherAETNA
NJ114015OtherVALUE OPTIONS
NJ0781211000OtherAMERIHEALTH