Provider Demographics
NPI:1871068916
Name:JEFFRIE POPPLEWELL LLC
Entity type:Organization
Organization Name:JEFFRIE POPPLEWELL LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFRIE
Authorized Official - Middle Name:
Authorized Official - Last Name:POPPLEWELL
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC, LCADC
Authorized Official - Phone:201-957-3497
Mailing Address - Street 1:300 GORGE RD APT 72
Mailing Address - Street 2:
Mailing Address - City:CLIFFSIDE PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07010-2770
Mailing Address - Country:US
Mailing Address - Phone:201-957-3497
Mailing Address - Fax:201-886-9531
Practice Address - Street 1:245 STANTON MT RD
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:NJ
Practice Address - Zip Code:08833-3106
Practice Address - Country:US
Practice Address - Phone:201-957-3497
Practice Address - Fax:201-886-9531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-04
Last Update Date:2019-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Single Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty