| Jeni Tyson Lcsw Llc | |
|
2115 Millburn Ave Ste 105 Maplewood NJ 07040-3724 | |
| (973) 738-3823 | |
| (973) 378-5577 |
| Full Name | Jeni Tyson Lcsw Llc |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 2115 Millburn Ave Ste 105, Maplewood, New Jersey |
| Authorized Official Name and Position | Jeanette M Tyson (OWNER) |
| Authorized Official Contact | 9737383823 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Jeni Tyson Lcsw Llc 2115 Millburn Ave Ste 105 Maplewood NJ 07040-3724 Ph: (973) 738-3823 | Jeni Tyson Lcsw Llc 2115 Millburn Ave Ste 105 Maplewood NJ 07040-3724 Ph: (973) 738-3823 |
| NPI Number | 1427466838 |
|---|---|
| Provider Enumeration Date | 07/29/2014 |
| Last Update Date | 07/29/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1427466838 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 44SC05337100 (New Jersey) | Primary |
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