Provider Demographics
NPI:1215964879
Name:CHANEY, JENNIFER LYNNE (MSW LCSW)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYNNE
Last Name:CHANEY
Suffix:
Gender:F
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:703 BROAD STREET
Mailing Address - Street 2:SUITE A 201
Mailing Address - City:SHREWSBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:07702-4219
Mailing Address - Country:US
Mailing Address - Phone:732-796-4609
Mailing Address - Fax:
Practice Address - Street 1:703 BROAD STREET
Practice Address - Street 2:SUITE A 201
Practice Address - City:SHREWSBURY
Practice Address - State:NJ
Practice Address - Zip Code:07702-4219
Practice Address - Country:US
Practice Address - Phone:732-796-4609
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-27
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC053103001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI408455OtherBLUE CHIP
RI30155-6OtherBLUE CROSS
RIJC31799Medicaid
RI62-94822OtherUNITED BEHAVIORAL HEALTH
RI007057324Medicare ID - Type Unspecified