MEDICARE: DR. JEANINE M SORENSEN PSY.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TS0200X	School Psychologist

General Provider Information

NPI Number	:	1902228778
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEANINE M SORENSEN PSY.D.

Provider Business Mailing Address
First Line	:	601 LINDELL BLVD
Second Line	:
City	:	LONG BEACH
State	:	NY
Zip	:	11561-1736
Country	:	US
Telephone Number	:	516-445-8503
Fax Number	:

Provider Business Practice Location Address
First Line	:	601 LINDELL BLVD
Second Line	:
City	:	LONG BEACH
State	:	NY
Zip	:	11561-1736
Country	:	US
Telephone Number	:	516-445-8503
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/14/2014
Last Update Date	:	01/14/2014

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