Healthcare Provider Details

I. General information

NPI: 1215484951
Provider Name (Legal Business Name): MISS JENNA L CUOCO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2016
Last Update Date: 02/05/2020
Certification Date: 02/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

506 STEWART AVE
GARDEN CITY NY
11530-4706
US

IV. Provider business mailing address

506 STEWART AVE
GARDEN CITY NY
11530-4706
US

V. Phone/Fax

Practice location:
  • Phone: 516-705-3400
  • Fax: 516-705-3418
Mailing address:
  • Phone: 516-705-3400
  • Fax: 516-705-3418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: