Provider Demographics
NPI:1427813328
Name:CARRASCO RODRIGUEZ, JENESIS NAHOMI
Entity type:Individual
Prefix:
First Name:JENESIS
Middle Name:NAHOMI
Last Name:CARRASCO RODRIGUEZ
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 1:22 COMFORT PL
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07011-3818
Mailing Address - Country:US
Mailing Address - Phone:615-956-5663
Mailing Address - Fax:
Practice Address - Street 1:22 COMFORT PL
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07011-3818
Practice Address - Country:US
Practice Address - Phone:615-956-5663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-19
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor