Healthcare Provider Details

I. General information

NPI: 1528820792
Provider Name (Legal Business Name): JENNA NICOLE SHARP LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2024
Last Update Date: 01/24/2024
Certification Date: 01/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 1ST AVE BLDG 129
ORANGEBURG NY
10962-1106
US

IV. Provider business mailing address

4 HARRIMAN DRIVE
GOSHEN NY
10924-1558
US

V. Phone/Fax

Practice location:
  • Phone: 845-680-4000
  • Fax:
Mailing address:
  • Phone: 845-615-0224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number11740
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: