Healthcare Provider Details

I. General information

NPI: 1780080168
Provider Name (Legal Business Name): JENNA KNOLL LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNA TYRANGEL MHC-LP

II. Dates (important events)

Enumeration Date: 11/12/2014
Last Update Date: 05/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 TILDEN STREET
BRONX NY
10467
US

IV. Provider business mailing address

LISA DRUCKREIER: HUMAN RESOURCES COORDINATOR 6339 MILL ST
RHINEBECK NY
12572
US

V. Phone/Fax

Practice location:
  • Phone: 718-231-3400
  • Fax: 718-655-3503
Mailing address:
  • Phone: 845-871-1099
  • Fax: 845-876-4578

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: