Provider Demographics
NPI:1588440838
Name:THEN, JOMELY
Entity type:Individual
Prefix:
First Name:JOMELY
Middle Name:
Last Name:THEN
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 1:1013 CHANDLER AVE APT 2A
Mailing Address - Street 2:
Mailing Address - City:LINDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07036-1862
Mailing Address - Country:US
Mailing Address - Phone:908-768-6649
Mailing Address - Fax:
Practice Address - Street 1:1013 CHANDLER AVE APT 2A
Practice Address - Street 2:
Practice Address - City:LINDEN
Practice Address - State:NJ
Practice Address - Zip Code:07036-1862
Practice Address - Country:US
Practice Address - Phone:908-768-6649
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-04
Last Update Date:2023-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst