Healthcare Provider Details

I. General information

NPI: 1598840944
Provider Name (Legal Business Name): JENNIFER MITGANG LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27010 GRAND CENTRAL PKWY APT 2A
FLORAL PARK NY
11005-1102
US

IV. Provider business mailing address

27010 GRAND CENTRAL PKWY APT 2A
FLORAL PARK NY
11005-1102
US

V. Phone/Fax

Practice location:
  • Phone: 516-395-1272
  • Fax: 516-706-1305
Mailing address:
  • Phone: 516-395-1272
  • Fax: 516-706-1305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberR068984
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: