| Doctor Name: | KELLY MARIE JENNER |
| NPI Number: | 1669634697 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 37PC00486500 |
| Business Practice Address: | 139 South St Suite 201 New Providence, NJ - 079741999 |
| Business Phone Number: | 9084776393 |
| Business Fax Number: | |
| Mailing Address: | 139 South St, Suite 201 NEW PROVIDENCE |
| State: | NJ |
| Postal Code: | 079741999 |
| Phone Number: | 9084776393 |
| Fax Number: | |
| NPI Enumeration Date: | 07/01/2008 |
| NPI Last Update Date: | 01/21/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 37PC00486500 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NJ |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |