Provider Demographics
NPI:1053876359
Name:CLEARWATERS, JENNIFER (MA, LPC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:CLEARWATERS
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2235 LAUREL DR
Mailing Address - Street 2:
Mailing Address - City:POINT PLEASANT BORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08742-5130
Mailing Address - Country:US
Mailing Address - Phone:914-443-9863
Mailing Address - Fax:
Practice Address - Street 1:2235 LAUREL DR
Practice Address - Street 2:
Practice Address - City:POINT PLEASANT BORO
Practice Address - State:NJ
Practice Address - Zip Code:08742-5130
Practice Address - Country:US
Practice Address - Phone:914-443-9863
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-31
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00625500101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ14399098OtherCAQH