Healthcare Provider Details

I. General information

NPI: 1467725366
Provider Name (Legal Business Name): JENNA ROSE GEYER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNA ECKNA LCSW

II. Dates (important events)

Enumeration Date: 02/23/2012
Last Update Date: 08/26/2024
Certification Date: 08/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 DOANSBURG RD
BREWSTER NY
10509-5902
US

IV. Provider business mailing address

400 DOANSBURG RD
BREWSTER NY
10509-5902
US

V. Phone/Fax

Practice location:
  • Phone: 845-279-2995
  • Fax: 845-279-4972
Mailing address:
  • Phone: 845-279-2995
  • Fax: 845-279-4972

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number084627
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: