Provider Demographics
NPI:1104335645
Name:AJOSA, JENNIFER MAYO (PSYD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:MAYO
Last Name:AJOSA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:JENNIFER
Other - Middle Name:MICHELLE
Other - Last Name:MAYO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSY D
Mailing Address - Street 1:110 WARREN AVE
Mailing Address - Street 2:SUITE 6
Mailing Address - City:HO HO KUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07423
Mailing Address - Country:US
Mailing Address - Phone:201-857-5380
Mailing Address - Fax:
Practice Address - Street 1:110 WARREN AVE STE 6
Practice Address - Street 2:
Practice Address - City:HO HO KUS
Practice Address - State:NJ
Practice Address - Zip Code:07423
Practice Address - Country:US
Practice Address - Phone:201-857-5380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-27
Last Update Date:2018-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00584900103TC0700X
NJ355100584900103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical