Provider Demographics
NPI:1528132586
Name:JAEGER, THERESA MARY (PHD)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:MARY
Last Name:JAEGER
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 1:44 SYCAMORE AVE
Mailing Address - Street 2:SUITE 3D
Mailing Address - City:LITTLE SILVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07739-1242
Mailing Address - Country:US
Mailing Address - Phone:732-425-3161
Mailing Address - Fax:
Practice Address - Street 1:44 SYCAMORE AVE
Practice Address - Street 2:SUITE 3D
Practice Address - City:LITTLE SILVER
Practice Address - State:NJ
Practice Address - Zip Code:07739-1242
Practice Address - Country:US
Practice Address - Phone:732-425-3161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00027300101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional