Healthcare Provider Details

I. General information

NPI: 1437172178
Provider Name (Legal Business Name): JENNIFER ROSE SENFT-MALTESE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER ROSE SENFT LMSW

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 01/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

998 CROOKED HILL RD
W BRENTWOOD NY
11717-1019
US

IV. Provider business mailing address

68 UNQUA RD
MASSAPEQUA NY
11758-6729
US

V. Phone/Fax

Practice location:
  • Phone: 631-761-3500
  • Fax: 631-761-2282
Mailing address:
  • Phone: 516-707-8225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number071279-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number076426-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: