Healthcare Provider Details

I. General information

NPI: 1245915214
Provider Name (Legal Business Name): JENNY SISMONDO MSW,LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2023
Last Update Date: 09/18/2023
Certification Date: 09/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 HIDDEN VALLEY RD
MC MURRAY PA
15317-2685
US

IV. Provider business mailing address

PO BOX 234
PERRYOPOLIS PA
15473-0234
US

V. Phone/Fax

Practice location:
  • Phone: 878-884-4312
  • Fax:
Mailing address:
  • Phone: 724-570-1103
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberSW140135
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW140135
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: