Provider Demographics
NPI:1356215719
Name:VIDAL, JINNET FRANCHESCA
Entity type:Individual
Prefix:
First Name:JINNET
Middle Name:FRANCHESCA
Last Name:VIDAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:418 MOUNT PROSPECT AVE APT 9
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07104-6116
Mailing Address - Country:US
Mailing Address - Phone:973-220-4068
Mailing Address - Fax:
Practice Address - Street 1:418 MOUNT PROSPECT AVE APT 9
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07104-6116
Practice Address - Country:US
Practice Address - Phone:973-220-4068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-30
Last Update Date:2025-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty