Provider Demographics
NPI:1285061747
Name:BAKER, JENNIFER A (LPC RPT ACS)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:A
Last Name:BAKER
Suffix:
Gender:F
Credentials:LPC RPT ACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 2ND AVE
Mailing Address - Street 2:APT 15C
Mailing Address - City:BRADLEY BEACH
Mailing Address - State:NJ
Mailing Address - Zip Code:07720-1184
Mailing Address - Country:US
Mailing Address - Phone:732-581-2178
Mailing Address - Fax:
Practice Address - Street 1:1044 LACEY RD
Practice Address - Street 2:SUITE 7
Practice Address - City:FORKED RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08731-1051
Practice Address - Country:US
Practice Address - Phone:732-581-2178
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-30
Last Update Date:2016-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00480700101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional