Provider Demographics
NPI:1194319624
Name:HEALEY, JANE M (PHD)
Entity type:Individual
Prefix:DR
First Name:JANE
Middle Name:M
Last Name:HEALEY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 N MAPLE AVE STE 101B
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-3261
Mailing Address - Country:US
Mailing Address - Phone:201-960-3571
Mailing Address - Fax:
Practice Address - Street 1:75 N MAPLE AVE STE 101B
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-3261
Practice Address - Country:US
Practice Address - Phone:201-960-3571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-25
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007290103G00000X
NJ304700103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist