Provider Demographics
NPI:1285297630
Name:JAEGEL, JEFFREY JR (LCADC)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:
Last Name:JAEGEL
Suffix:JR
Gender:M
Credentials:LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 RUSTIC TRL
Mailing Address - Street 2:
Mailing Address - City:FLEMINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08822-5550
Mailing Address - Country:US
Mailing Address - Phone:908-782-0483
Mailing Address - Fax:
Practice Address - Street 1:8 RUSTIC TRL
Practice Address - Street 2:
Practice Address - City:FLEMINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08822-5550
Practice Address - Country:US
Practice Address - Phone:908-782-0483
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-20
Last Update Date:2019-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00240700101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty