Provider Demographics
NPI:1346571379
Name:CARLIN-MATHIS, JENNIFER R (PHD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:R
Last Name:CARLIN-MATHIS
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 1:130 POMPTON AVE
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:NJ
Mailing Address - Zip Code:07044-2943
Mailing Address - Country:US
Mailing Address - Phone:973-857-4400
Mailing Address - Fax:973-857-4411
Practice Address - Street 1:130 POMPTON AVE
Practice Address - Street 2:
Practice Address - City:VERONA
Practice Address - State:NJ
Practice Address - Zip Code:07044-2943
Practice Address - Country:US
Practice Address - Phone:973-857-4400
Practice Address - Fax:973-857-4411
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-14
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00471700103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist