Provider Demographics
NPI:1699093419
Name:WEBERMAN, JENNIFER R (PSYD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:R
Last Name:WEBERMAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 TUDOR CT
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07081-3029
Mailing Address - Country:US
Mailing Address - Phone:201-341-8023
Mailing Address - Fax:
Practice Address - Street 1:110 HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07081-3030
Practice Address - Country:US
Practice Address - Phone:201-341-8023
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-05
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00462100103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist