Provider Demographics
NPI:1689994725
Name:SPENGLER, JAYNE (LCSW, LCADC)
Entity type:Individual
Prefix:MRS
First Name:JAYNE
Middle Name:
Last Name:SPENGLER
Suffix:
Gender:F
Credentials:LCSW, LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 CLYDE RD STE 202
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-3474
Mailing Address - Country:US
Mailing Address - Phone:908-947-6136
Mailing Address - Fax:
Practice Address - Street 1:3 CLYDE RD STE 202
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-3474
Practice Address - Country:US
Practice Address - Phone:908-947-6136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-10
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SCO56115001041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP01705806OtherRAILROAD MEDICARE PROVIDER TRANSACTION ACCESS NUMBER (PTAN)
NJ0023701OtherAGENCY MEDICAID PROVIDER #
NJ527486OtherAGENCY MEDICARE PROVIDER #
NJ47-2771193OtherTAX ID