Healthcare Provider Details

I. General information

NPI: 1962948026
Provider Name (Legal Business Name): JENNY YOVINE LCSW PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2017
Last Update Date: 10/07/2021
Certification Date: 10/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

79 TACONIC RD
MILLWOOD NY
10546-1126
US

IV. Provider business mailing address

79 TACONIC RD
MILLWOOD NY
10546-1126
US

V. Phone/Fax

Practice location:
  • Phone: 646-872-8485
  • Fax:
Mailing address:
  • Phone: 646-872-8485
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR075786-1
License Number StateNY

VIII. Authorized Official

Name: JENNY L YOVINE
Title or Position: OWNER
Credential: LCSW
Phone: 646-872-8485