Active NPI
Jeanette Fox Bouroult, PSYD
- Psychologist
- Rockaway, NJ
National Provider Identifier
1962191304
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 35SI00711500
- Practice address
- 217 E Main St
Rockaway, NJ 07866-3602 - Phone
- (973) 983-3919
- NPI assigned
- May 2, 2023
- Last updated
- May 2, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 35SI00711500 | NJ | Primary |
Addresses
Primary practice location
217 E Main St
Rockaway, NJ 07866-3602
Mailing address
5 King Hill CT
Denville, NJ 07834-3409
Phone (860) 916-5135
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 35SI00711500 | NJ | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1682985600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1682985600000",
"number": "1962191304",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5 KING HILL CT",
"city": "DENVILLE",
"state": "NJ",
"postal_code": "078343409",
"telephone_number": "860-916-5135"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "217 E MAIN ST",
"city": "ROCKAWAY",
"state": "NJ",
"postal_code": "078663602",
"telephone_number": "973-983-3919"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOUROULT",
"first_name": "JEANETTE",
"middle_name": "FOX",
"name_prefix": "Dr.",
"credential": "PSYD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-05-02",
"last_updated": "2023-05-02",
"certification_date": "2023-05-02",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "NJ",
"license": "35SI00711500",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rockaway, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.