Provider Demographics
NPI:1154135101
Name:DRAKE, JENNIFER P (LCSW)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:P
Last Name:DRAKE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:ANN
Other - Last Name:PERGAMENT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:636 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HIGHTSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08520-3400
Mailing Address - Country:US
Mailing Address - Phone:732-995-7674
Mailing Address - Fax:
Practice Address - Street 1:4 PRINCESS RD STE 206
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08648-2322
Practice Address - Country:US
Practice Address - Phone:609-482-3701
Practice Address - Fax:609-482-3702
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-01
Last Update Date:2025-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC053215001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical