Provider Demographics
NPI:1992077549
Name:SMYTH-KAUFFMANN, JESSE LYNN (LCSW)
Entity type:Individual
Prefix:MS
First Name:JESSE
Middle Name:LYNN
Last Name:SMYTH-KAUFFMANN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 SUNNYSIDE RD
Mailing Address - Street 2:
Mailing Address - City:LINCROFT
Mailing Address - State:NJ
Mailing Address - Zip Code:07738-1109
Mailing Address - Country:US
Mailing Address - Phone:908-670-5566
Mailing Address - Fax:
Practice Address - Street 1:103 MAPLE AVE STE 201
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-1715
Practice Address - Country:US
Practice Address - Phone:908-670-5566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-29
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ7057681041S0200X
NJ44SC054895001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool